IHP news 610 : Perseverance

( 26 Feb 2021)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

When the first vaccine doses distributed by COVAX landed in Ghana earlier this week, it felt a bit like the Perseverance’s landing on Mars. Ouf! At last. Neil Armstrong probably also nodded approvingly from heaven, when hearing some of the rhetoric: “Wonderful words from @UNICEF Covax Coordinator Gian Gandhi as the first ACTA flight hits the ground in Ghana: « A short flight, and small step to reduce inequities in vaccine access... but a huge achievement that’s been almost 10 months in the making». Anyway, encouraging and great news, not a day too soon.

Still, the picture on global vaccine equity remains bleak in the short term, for the reasons you know. Yes, there is a growing movement behind vaccine equity, as dr. Tedros claimed last week, and multilateralism made a cautious comeback at the G7 summit (with Covax getting a (much needed) shot in the arm). WHO officials can now be (a bit) more optimistic about successfully getting around 2 billion vaccine doses to at least 20% of the populations of 92 lower-income economies by the end of 2021. But they shouldn’t get carried away too soon, as this (excellent) COVAX “state of affairs” piece in Stat argued: “more is needed to ensure global vaccine access”. A quote from Kenneth Shadlen put things in perspective: “It would be great if COVAX can help us avoid a worst-case scenario of poor countries having no vaccines until 2022 or later. That’s an accomplishment that we can celebrate, but we should also recognize the accomplishment for what it is – avoiding a worst- case scenario.” Even if there are probably also epidemiological and cost-effectiveness arguments complicating the vaccine equity debate a bit in some (of the relatively less hit) regions of the world, the last thing you want in this pandemic is that social spending in LMICs gets cut even more than already is the case, because they have to purchase vaccines at "above rich world" prices.

Over here in Europe, ‘Team Europe’ and Emmanuel Macron’s version of global solidarity continues to contain a strong dose of geopolitics, but perhaps that was always unavoidable, given how most leaders are wired. What is far less unavoidable, though, is the continued opposition of rich countries (with big pharmaceutical industries) to the TRIPS waiver proposal, where things remain deadlocked. Against that backdrop, the question has to be raised, as Sophie Harman pointed out in a tweet, “whether COVAX was set up to avoid any discussion on IP and TRIPs waivers for COVID vaccines. Is COVAX part of problem not solution to #PeoplesVaccine?”

I wouldn’t go that far. COVAX (and ACT-A) are no doubt needed on the journey towards a “People’s Vaccine” in this grossly unfair and imperfect world of ours, even if they clearly don’t suffice. On the latter, Nick Dearden (Global Justice Now), put it like this after the G7 meeting: “The Elephant in the Zoom” remains Big Pharma patents. And so, borrowing a line from NASA, I hope global civil society ‘Perseveres’ with its essential battle to overcome the artificially constrained supply, and (in the process) the current global vaccine distribution “zero-sum game”. Fortunately, People’s Vaccine proponents have some great allies like Winnie Byanyima and John Nkengasong – not to mention the

1

Holy See! And perhaps dr. Tedros can also give a hand, by tweeting on the TRIPS waiver: ‘Perseverance’ ?

Over to the US administration then, and the “new wind” that comes with it . When I see Joe Biden’s calm demeanor, just “getting to business” and “doing what needs to be done”, I wonder to what extent you also see the (somewhat sad) difference between (at least some) in his generation, and the “neoliberalized individuals” we have all become in the past 30 years, consciously or subconsciously, (self-)branding and competing with each other all the way till the very destruction of our planet. I’m not a big fan of Branko Milanovic’s writings on degrowth, but sadly, this assessment in a blog by him this week was spot on: “capitalism, and thus both the relentless search for profit and the value system that places wealth on the pedestal, is more dominant than ever. Had degrowers preached material abstinence in 13th century Europe or 10th century Byzantium it might have had more appeal. Commercial society, capitalism, numerical abilities were far less developed than today. But now, the relevance of moral preaching of abstinence is close to zero. …”.

But let’s end this intro with dr. Tedros. As some pointed out, WHO statements targeting specific countries are rare, but Tedros did single out Tanzania last week (for good reason). At Monday’s WHO media briefing, dr. Tedros also lashed out at High-Income countries for snapping up vaccine supplies. No prizes to be won for which criticism is most important in this world of ours.

Enjoy your reading.

Kristof Decoster

Featured Article

The Future of Global Health Leadership: reflections of the IWG Fireside Chat

Ghiwa Nasser Eddine, Laura Haywood, Malvikha Manoj, Magali Collonnaz (all are IWG members)

The International Working Group for Health Systems Strengthening (IWG) is an international collaborative of emerging public health professionals committed to meaningful health systems reform. To better understand what makes a leader, we hosted a fireside chat in December, called ‘Looking Back, Looking Forward’, with three trailblazers in their fields: Dr. Kabir Sheikh, Dr. Rene Loewenson, and Dr. Roopa Dhatt. The discussion aimed to explore the paths that these three individuals have paved in the field of global health and to inspire conversations and actions for reform. Three essential lessons emerged:

1. Advocacy rooted in core values: Identifying a core vision, mission, and goals, and centering them within a strong value system that can guide your advocacy efforts, can help rally other like-minded collaborators towards your cause.

2

2. Collective successes over Individual successes: In public health, as is common across many other spaces, the success of one requires the success of many. 3. People-centered comprehensive public health: Public health professionals should always consider, engage and work with the members of the community as the most critical aspect of every initiative they intend to implement.

Following this, IWG members had a ‘think in’ to reflect on the speakers’ ideas and collate different recommendations that emerging public health professionals may consider insightful in setting their own paths.

Study the history of global health, and critically examine who holds power as well as how your work shapes the distribution of power. Global health emerged from a colonial legacy and it could be argued that these tendencies are still perpetuated in modern times in different ways. Power imbalances across gender, race, and geography are still abundant in the space. As emerging global health leaders, we have a responsibility to question how this history has shaped the mistrust and division that exists within public health, and then commit to tangible actions to address these issues.

Identify, adhere to, and come back to your values and convictions regularly. Values can be critical drivers that shape aspirations and intentions in the field of global health. Our ‘values’ are not simply words to write down, but they are actions to live by.

Find your team. Collaborate. In order to strengthen health systems that work for all, we need diverse, empowered voices on the team. We should continue to ask who is at the table, and perhaps more importantly, who is not at the table; and why. If the table is not big enough, create a new one.

Negative emotions can be a powerful tool for deeper and more meaningful discussions and actions, and can lead to positive reform if channeled well. Channel negative emotions into positive strategies and understand that what we feel is “wrong” or “unjust” can go a long way in helping us address the issues we are passionate about.

Global health is a complex, dynamic, and fulfilling field. Ultimately, it is up to each of us to be the change we want to see around us: the pandemic has opened a window of opportunity for us to step up and move towards a more just vision for public health.

Full article: https://iwghss.org/2021/02/09/iwg-fireside-chat/

Acknowledgements: We would like to thank Dr. Roopa Dhatt, Dr. Rene Loewenson, and Dr. Kabir Sheikh for their meaningful and thoughtful remarks during the IWG Fireside Chat, as well as their feedback on this output: their constructive suggestions and ideas have helped shape the final output published here.

We would also like to thank our fellow IWG Global Lecture Series working group members (in alphabetical order): Bronte Davies, Faye Roderos, James Coughlan, Lynn Bust, Mabel Aoun, Meena Taffazoli, Nuria Gallego, Philip Dambisya, Pushpak Mahajan, and Reiner Tamayo.

For more information about the IWG, stay connected on our social media platforms: Website, Facebook, Twitter, Instagram.

3

Highlights of the week

Global Tax Justice

Tax Justice Network - Heads of state launch historic UN plan to stamp out global tax abuse https://www.taxjustice.net/press/heads-of-state-launch-historic-un-plan-to-stamp-out-global-tax- abuse/

“A group of heads of state from around the world are today launching a blueprint for a UN tax convention and a new intergovernmental tax body under the UN to radically tackle rampant global tax abuse, which is currently estimated to cost countries over $427 billion in lost revenues to tax havens every year. The report from a high-level UN panel, provides a comprehensive set of recommendations that reflect in full the policy platform created by the Tax Justice Network since its formal establishment in 2003. The panel identifies tax abuse and other illicit financial flows as a systemic problem that “robs billions of a better future” and that can only be addressed by “nothing less than a transformation of the global financial system” led at the United Nations….”

“… The seminal blueprint was prepared by the UN High-Level Panel on International Financial Accountability, Transparency and Integrity, which launched in March 2020 to study the impact of tax abuse, money laundering and illicit financial flows on the ability of states to meet the UN’s Sustainable Development Goals by 2030. … … signalling the strongest levels of global support to date for efforts to bring international taxation under the mandate of the UN. … … The high-level UN panel’s report draws scathing conclusions on the current patchwork of international tax rules and structures that have been largely set by the OECD … The high-level UN panel sets out 14 recommendations in its ambitious blueprint to “free the global economy from illicit financial practices”, most monumental of which are the adoption of a UN tax convention and establishment of an intergovernmental body on tax matters under the UN. The panel states these actions would allow international tax standards to be established through an open and inclusive legal instrument with universal participation. In practice, these two actions would shift the power to set global tax rules away from the OECD, which has held the seat of power on global tax for 60 years, to the United Nations This would then make it possible to push forward the policy package laid out in the rest of the recommendations made by the high-level UN panel, and which reflects in full the policy platform long advocated for by the global tax justice movement…”

Related blog by Alex Cobham: A tide-turning moment in the global struggle for tax justice.

Coverage: Euractiv - Global agreement on corporate tax rates needed, UN report states

G7 summit (UK: virtual host)

G7 Leaders declaration: https://www.g7uk.org/joint-statement-of-g7-leaders-19-february-2021/

4

HPW - US & G7 Countries Make US$ 4.3 Billion In New Commitments To COVAX – Novavax Commits 1.1 Billion Doses https://healthpolicy-watch.news/us-g7-countries-make-us-7-5-billion-in-new-commitments-to- covax-novavax-commits-1-1-billion-doses/

“The United States is donating an additional US$2 billion to the COVAX facility over the next two years to facilitate the equitable distribution of COVID-19 vaccines to low- and middle-income countries, while the pharma company Novavax will provide a total of 1.1 billion doses of its vaccine to COVAX – a gesture that could increase the available vaccine supplies for the global facility by one- third for 2021. The commitment by the US was met by an EU announcement that it would be doubling its COVAX funding, adding an additional €500 million and bringing its total contribution to €1 billion. Germany pledged an additional US$1.8 billion to the Access to COVID-19 Tools (ACT) Accelerator, the majority of which will go towards COVAX, the vaccine platform. Japan committed US$79 million to COVAX as well as Unitaid, and Canada pledged US$59 million. The commitments bring the total funding for the ACT Accelerator to US$10.3 billion, leaving a funding gap of US$22.9 billion for 2021 to fully fund the Accelerator’s work. In addition, the UK and France commited to share some of their surplus doses with low-and middle-income countries after a report that rich countries have stockpiled at least 1 billion vaccine doses more than they need to immunize all of their citizens….”

PS: a few days later, Germany also committed to sharing doses (HPW)

See also the Guardian - G7 pledges extra $7bn towards Covid vaccines for world's poorest

Guterres on the need for a G20 emergency task force: “… the UN secretary general said the current effort to distribute doses equitably was chaotic and that a global emergency plan to fight the virus was needed. … The UN secretary general, however, told the Munich Security Conference that 75% of vaccines had been monopolised by 10 countries, while more than 100 countries had not received a single dose. António Guterres suggested that the wider G20 group of countries should set up an emergency team that could create a global vaccination plan. It should bring together countries, companies, international organisations and financial institutions with the “necessary power, scientific expertise and production and financing capacity”, he said, adding that he could mobilise the entire UN system for the task. … Bill Gates said the world’s poorest countries were at least six months behind the vaccine progress of the wealthy….” “

PS: via Euractiv - Paris to bring African vaccine strategy on the table at EU virtual summit (25 Feb): “When EU heads of states and government hold an online meeting on Thursday (25 February), they will discuss a proposal by French President Emmanuel Macron to send 13 million doses of COVID-19 vaccines to African countries. ”

FT - G7 leaders vow to boost vaccine supplies to developing world

View from the World Bank: “… David Malpass, president of the World Bank, welcomed what he said was a new “spirit of international cooperation” by G7 nations and its enlarged commitments to Covax. “I’m cautiously optimistic that, as the new vaccines are approved and there’s competition within the market between suppliers, that is going to begin to unlock the supply,” he said. However, Malpass said that a lack of transparency of contracts and delivery schedules was hampering the effort to get vaccines to developing countries quickly. “It’s unclear which of the manufacturers have

5

committed to which of the delivery schedules and how much has been committed to Covax,” he said. He also said that some manufacturers were diverting supplies to wealthier countries that had agreed to pay more for doses rather than poor ones through discounted rates negotiated by Covax and bodies such as the African Union. “The manufacturers are reluctant to commit the doses to developing countries while they have the chance to sell it, or provide it, at a higher price to the advanced economies,” he said….”

Global Justice Now - G7 vaccine pledge is ‘fig leaf’ for global apartheid

N Dearden; https://www.globaljustice.org.uk/news/2021/feb/19/g7-vaccine-pledge-fig-leaf-global- apartheid

Civil society isn’t convinced yet of the ‘breakthrough’. “Communiqué falls short on urgent lack of supply caused by Big Pharma’s patents – ‘The Elephant in the Zoom” .

AP - UK to push at G-7 for global standard on ‘vaccine passports’ AP;

“ Britain plans to use its presidency of the Group of Seven economic powers to push for an internationally recognized system of vaccine passports that could allow world travel to resume, though Prime Minister Boris Johnson acknowledged Tuesday that the idea raises “complex” ethical issues….”

Guardian - UK urged to take lead in easing debt crisis in developing countries https://www.theguardian.com/world/2021/feb/21/uk-urged-take-lead-easing-debt-crisis- developing-countries-g7

“Boris Johnson should use upcoming G7 presidency to insist UK banks join debt suspension schemes, campaigners say. “ “Boris Johnson should use his presidency of the G7 this year to insist that UK banks take part in the global push to alleviate a new developing country debt crisis, a campaign group has urged. The Jubilee Debt Campaign (JDC) said there was a special responsibility on Britain to act, as it released new figures showing that London-based banks were the largest owners of debt issued by poor countries. With steps being taken in New York to make debt restructuring easier, the JDC said the UK was now the most important country when it came to unblocking multilateral debt relief efforts….”

And some links:

GAVI - G7 backs Gavi's COVAX Advance Market Commitment to boost COVID-19 vaccines in world’s poorest countries (press release)

Devex - Inoculating UK population before donating vaccines undermines country's claim to pandemic leadership, experts say

6

Other Global health governance & financing news

BMJ Editorial - The case for an international pandemic treaty

H Nikogosian & I Kickbusch; https://www.bmj.com/content/372/bmj.n527

“A treaty would protect lives, livelihoods, security, and human rights.”

“…The debate around whether—and where—an international pandemic treaty or other strong international framework should be negotiated is likely to take centre stage globally in the coming months. In our view, any decision to negotiate a global health treaty should meet three criteria: the problem should be of a global concern and growing magnitude; transnational factors must play a dominant role; and existing instruments must be inadequate. Pandemics meet the first two criteria, and probably the third given ongoing debate about the adequacy of the International Health Regulations during covid-19. In principle, a new treaty could be negotiated under the auspices of WHO, the UN, or both….”

They conclude: “…A pandemic treaty under the joint auspices of WHO and the UN seems the most viable way forward given the urgency and the implications of the current pandemic beyond health to livelihoods, economies, security, solidarity, and human rights. If a treaty is deemed not immediately feasible, a UN framework with built-in power and mandate to negotiate a treaty could be the road to take.”

Stat - Dozens of institutional investors push for ‘fair and equitable’ Covid-19 response https://www.statnews.com/pharmalot/2021/02/23/covid19-coronavirus-vaccine-who-covax- fidelity/

“Nearly 150 institutional investors that oversee combined assets worth more than $14 trillion have issued a joint call for a “fair and equitable” global response to the Covid-19 pandemic, and they intend to huddle with health care companies to make progress on that goal. The investors are eyeing three efforts, starting with greater financing for the ACT Accelerator partnership … They also plan to work with the Access to Medicines Foundation, a nonprofit that tracks pharmaceutical industry progress on widening access to its products, to promote “cross-industry partnerships.” These partnerships would be focused on accelerating R&D, expanding production, creating equitable pricing strategies, and establishing voluntary licensing agreements for vaccines and medicines. In addition, the investors plan to explore the feasibility of innovative finance mechanisms for national and global Covid-19 responses, similar to new vaccine bonds or social bonds being issued for Covid-19 programs. Last year, for instance, Novartis (NVS) sold bonds tied directly to its progress in making medicines accessible in certain low- and middle-income countries. … … Among the 148 institutional investors that support the effort are Asset Management One, Fidelity International, Nordea, Sumitomo Mitsui Trust Asset Management and Alliance Bernstein. Their goal is to achieve for Covid-19 and pandemic preparedness what investors have done for the Paris Conference and subsequent UN Climate Change Conferences….”

7

Lancet World Report – New WTO leader faces COVID-19 challenges https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00507-9/fulltext

“Ngozi Okonjo-Iweala is the first woman and the first African to lead the World Trade Organization. She already faces scrutiny over intellectual property rights in the pandemic. John Zarocostas reports.”

“Her comments [on a “Third Way”] have drawn a mixed response. Germán Velásquez, special adviser on policy and health of the South Centre, told The Lancet that “her statement is in fact against the proposal from India and South Africa”, and critically noted that Okonjo-Iweala's statement “was more on voluntary licences and voluntary agreements by the manufacturers. We know very well that it is useless.”” The only help that can come from the WTO is the use and the promotion on the acceptance of the promise on the use of the flexibilities of the TRIPS agreement and the main possibility is the compulsory licence system”, he noted….”

“…Rohit Malpani, a Unitaid board member and consultant, told The Lancet: “She must find a way to build consensus to support the petition by low and middle income countries (led by South Africa and India) to temporarily suspend all intellectual property rules for COVID-19 medical technologies. The need for a waiver was already apparent last October, and with the ever-widening disparity of access to vaccines, it is now impossible to ignore.”…”

Guardian - Reporting on WTO's first female head 'sexist and racist', say African UN leaders https://www.theguardian.com/global-development/2021/feb/23/reporting-on-wto-first-female- head-sexist-and-racist-say-african-un-leaders-ngozi-okonjo-iweala

“Senior African leaders at the UN have criticised the “sexist and racist” language used in coverage of the appointment of Ngozi Okonjo-Iweala as the new president of the World Trade Organization….”

Trade Beta blog - Ngozi Okonjo-Iweala is the new WTO chief, but let’s not get carried away P Ungphakorng; https://tradebetablog.wordpress.com/2021/02/15/n-o-i-new-wto-chief/

Insightful blog on what (reasonably) can be expected from a WTO boss. “The director-general’s powers are limited, so don’t expect miracles. And don’t blame her if problems stay unresolved.”

Guardian - Italy 'misled WHO on pandemic readiness' weeks before Covid outbreak https://www.theguardian.com/world/2021/feb/22/italy-misled-who-on-pandemic-readiness-weeks- before-covid-outbreak

“(IHR) Preparations not reviewed since 2006 but self-reporting in February 2020 claimed they were at highest level. “

8

Devex - With scarce funding for ACT-A, 'everything moves slower': WHO's Bruce Aylward https://www.devex.com/news/with-scarce-funding-for-act-a-everything-moves-slower-who-s- bruce-aylward-99195

“ The World Health Organization-led Access to COVID-19 Tools (ACT) Accelerator is considering the potential of a burden-sharing model to unlock much needed financing. The global initiative remains severely underfunded almost 10 months since its launch in April 2020, although it received a financing boost from G-7 leaders last week. Under the concept of burden sharing, countries will be asked to contribute based on their gross domestic product per capita and economic openness, as defined by the International Monetary Fund. Projected asks include more than $5 billion for the United States alone, although this is not yet final and still being discussed with country officials.

“… … . But even with the additional funding boost at the G-7 last Friday, it is still short of $22.9 billion. … Compared to the U.S. government’s Operation Warp Speed and the European Union, the COVAX Facility’s “war chest is not big enough,” the WHO official said.”

“Aylward has also commented on emerging narratives against COVAX. “I see people announcing that, ‘Oh we want to do this with COVAX, but COVAX isn't ready’ … but COVAX was ready in December. That is a self-fulfilling prophecy,” he said. “If you don't want to donate vaccines through COVAX, or you don't want to finance … COVAX, you don’t want to buy your vaccines through it, you know, admit it that you want to jump the queue, or admit that you know you want to do a bilateral deal with a friendly country or something else, but don't blame COVAX,” he added….

“… Insufficient funding also prevents WHO and its multilateral partners from buying test kits for which it has volume and price guarantees. Lack of testing can lead to the virus spreading in populations undetected. “Look at the map of where COVID diseases [are] today and where variants are today. There [are] holes all over it. There's insufficient testing out there. We don’t know the enemy well enough,” Aylward said. …. … The funding crunch can impact COVID-19 treatment too. While there’s now an effective treatment against severe COVID-19, Aylward said dexamethasone works if a patient is also given oxygen. But a number of countries are experiencing oxygen supply shortages, including those in sub-Saharan Africa. Oxygen can be challenging to deliver to countries, too. …. With insufficient funding, “everything moves slower … that's the bottom line,” Aylward said.”

Wilson Center (Transatlantic Series) - A transatlantic cure to the pandemic and structural global health shortcomings?

R Van de Pas & L van Schaik; https://www.wilsoncenter.org/article/transatlantic-cure-pandemic- and-structural-global-health-shortcomings

With a number of recommendations for US-EU cooperation in improving global health governance.

9

Telegraph - UK government creates new 'global health' team to tackle pandemic and beyond https://www.telegraph.co.uk/global-health/science-and-disease/uk-government-creates-new- global-health-team-tackle-pandemic/

“The new directorate in the Foreign, Commonwealth and Development Office is a sign of a renewed focus on global health post Covid-19.”

“…The new team will prioritise tackling the pandemic as well as coming up with strategies for how to prevent the next threat. Bringing down the huge numbers of preventable deaths of mothers and babies around the world is also at the top of the to-do list.”

Münich Security conference (last weekend)

UN News - UN chief to security meeting: ‘2021 must be the year to get back on track’ “By exposing deep fissures and fragilities, “COVID-19 has x-rayed the world”, the UN chief told the Munich Security Conference on Friday, while acknowledging that today’s vulnerabilities go “well beyond” pandemics and public health.”

Reuters - More than 200 groups urge G20 to back IMF issuance to help poor countries in pandemic https://www.reuters.com/article/us-g20-imf/more-than-200-groups-urge-g20-to-back-imf-issuance- to-help-poor-countries-in-pandemic-idUSKBN2AO2ZR

Ahead of a G20 meeting: “Jubilee USA Network, Oxfam and 215 other civil society groups on Wednesday urged Group of 20 finance officials to back an issuance of $3 trillion of the IMF’s own currency, or Special Drawing Rights, to help countries weather the COVID-19 pandemic. In an open letter to the International Monetary Fund and G20 finance ministers, the groups said a new allocation of SDRs would boost the reserves of all countries and avoid pushing low- and middle- income countries further into debt distress. G20 finance ministers and central bankers will discuss a possible SDR issuance - a move akin to a central bank printing money - when they meet by video conference on Friday. Proponents note that such a move will not add cost for the IMF members. Italy, which leads the G20 this year, is pushing for a smaller $500 billion allocation of SDRs, which can be converted to hard currency by IMF members - a move backed by France, Germany and others, but still lacking support from Washington.”

But the US stance seems to be changing. Via FT: “US Treasury secretary Janet Yellen has taken the first steps to reverse Washington’s opposition to more financial support for low-income countries through the IMF to help ease the economic impact of the pandemic. In a letter to her G20 counterparts on Thursday, Yellen signalled her provisional support for a new allocation of special drawing rights (SDR) — the IMF’s reserve currency which is used to supplement member countries’ official reserves….”

10

And via Devex: “ The letter also called for greater support of a rapid global vaccination program, which Yellen called “the strongest stimulus we can provide to the global economy.”

“G-20 leaders are likely to wait for an IMF needs assessment before making their decision … … While these issues are likely to come up at the G-20 meeting Friday, approval of new SDRs would come at the IMF meeting in April at the earliest.”

On the agenda of the G20 meeting: fiscal and monetary policy support for the COVID recovery, debt moratoriums, financial inclusion and international taxation.

Columbia University symposium on COVID-19 vaccine development, strategy and implementation (22-26 Feb) https://www.pgh.cuimc.columbia.edu/symposium-vaccines-and-global-health-covid-19-vaccine- development-strategy-and-implementation

Columbia University convenors “put together a group of 25 outstanding speakers who have been intimately involved with all aspects of COVID-19 vaccine development, strategy, and implementation. We are delighted to present this five-day virtual symposium at the cusp of the world’s transition to controlling the COVID-19 pandemic…”

Remarkably, global civil society was absent from the line-up, as far as I can tell. And most speakers seemed to be focusing on ACT-A (including Covax) – hardly mentioning the TRIPS waiver proposal. (#globalhealthhegemony ?)

Co-organized by WHO, the Bill & Melinda Gates Foundation, and the NIAID.

Some coverage: HPW - ‘Rapid Response Platforms’ Enabled COVID-19 Vaccine Development, Says Fauci

Covid key news

Focus on global trends, key WHO messages & other new initiatives.

Two sad milestones this week: the US passed 500000 deaths, Brazil 250000…

WHO says global deaths down 20% since last week; cases declining for six straight weeks Guardian;

11

“The World Health Organization says that global deaths from coronavirus-related complications have declined by 20% in the last week, with cases dropping for the sixth consecutive week worldwide. Deaths have been falling for three consecutive weeks….”

Via Cidrap News:

“Some 66,000 deaths were reported last week, according to the UN agency’s latest update on the disease, which was issued on Wednesday. WHO said deaths have fallen in all regions except the Western Pacific, which recorded a six per cent increase. New infections also decreased by 11 per cent over the same period in four out of six regions. However, South-East Asia and the Eastern Mediterranean reported small increases of two per cent and seven per cent respectively. Globally, there have been nearly 111 million cases of COVID-19 since the start of the pandemic, and more than 2.4 million deaths….”

Global COVID-19 cases fell for the sixth week in a row. See WHO’s weekly snapshot.

G-7 Commitments Of US$4.3 Billion Not Enough – Rich Countries Need To Stop COVID Vaccine Hoarding to Open Access Bottleneck, Says WHO Director General https://healthpolicy-watch.news/g-7-commitments-of-us4-3-billion-welcome-but-rich-countries- need-to-stop-covid-vaccine-surpluses-stop-hoarding-says-who-director-general/

Tedros lashed out at WHO’s first media briefing of the week. For good reason.

“Despite Friday’s commitment by G-7 countries to donate another US$ 4.3 billion to a global COVID vaccine campaign, World Health Organization Director General, Dr Tedros Adhanom Ghebreyesus has accused high-income nations of still undermining equitable vaccine rollout by “doing deals” with manufacturers that deplete supplies available to the COVAX global vaccine facility. Speaking at the WHO’s biweekly media briefing, Tedros thanked the G-7 and the European Union for the new donations – but stressed that money was not enough: “If there are no vaccines to buy, money is irrelevant. Currently, some high-income countries are entering contracts with vaccine manufacturers that undermine the deals that COVAX has in place and reduce the number of doses COVAX can buy,” said Dr Tedros….”

HPW - COVAX Sets Up ‘No-Fault’ Compensation Fund “… Earlier in the day COVAX announced that the WHO had reached an agreement with a global third party insurance provider, ESIS Inc, to administer a no-fault vaccine injury compensation programme for the 92 low- and middle-income countries and economies eligible for donor support to their vaccine campaigns….”

For more detail, see WHO - No-fault compensation programme for COVID-19 vaccines is a world first

“New programme makes compensation available to eligible individuals in 92 low- and middle-income countries without need to resort to law courts; This is the first and only global vaccine injury compensation mechanism; The programme is funded by a small levy on each dose supported by the Gavi COVAX AMC…”

12

And more coverage via Reuters – WHO agrees compensation fund for serious COVAX vaccine side effects

“… The WHO-agreed plan, which has been under discussion for several months, is designed to cover serious side effects linked to any COVAX-distributed vaccines until June 30, 2022, to COVAX’s Advance Market Commitment-eligible economies - a group of 92 poorer states which includes most African and Southeast Asian countries. The programme will be financed initially from donor funding to the AMC as an extra charge on all doses of COVID-19 vaccines distributed through COVAX. Applications can be made via a portal at www.covaxclaims.com from March 31, 2021, the WHO said….”

COVID-19 Emergency Oxygen Response https://stoppneumonia.org/covid-19-emergency-oxygen-response-2/

The Access to COVID-19 Tools Accelerator (ACT-A) announced a COVID-19 Emergency Oxygen Response to help the worst-affected low- and middle-income countries (LMICs) ensure that no more COVID-19 patients die for lack of oxygen. Unitaid and the Wellcome Trust established a COVID-19 Emergency Oxygen Taskforce* as part of the ACT-A “Therapeutics” pillar.

See also WHO - COVID-19 oxygen emergency impacting more than half a million people in low- and middle-income countries every day, as demand surges

“…New assessments show US$90 million immediate funding required to meet urgent need in up to 20 low- and middle-income countries (LMICs). Unitaid and Wellcome will make an immediate contribution of up to US$20 million in total for the emergency response. COVID-19 Oxygen Emergency Taskforce brings together key organisations working on oxygen access under ACT- Accelerator Therapeutics pillar, as COVID-19 surges and preventable deaths occur…”

Via FT - “Aid agencies are ready to disburse more than $90m in funding for emergency oxygen supplies in low income countries struggling to treat patients with Covid-19, ahead of a broader campaign to raise $1.6bn in the coming months. Wellcome and Unitaid have pledged an immediate $20m, as part of a plan to accelerate support for medical oxygen, and will oversee $1.6bn freshly allocated for oxygen as part of the therapeutics unit of Act-A, a World Health Organization programme which is developing tools to tackle the pandemic. The World Bank, which with the Global Fund to Fight Aids, Tuberculosis and Malaria oversees the separate health systems division of Act-A, is also preparing to allocate $90m to meet requests from health ministries and support large-scale oxygen plant construction….”

Coverage via HPW - Oxygen Is Life – Particularly for COVID-19 Treatment – New Taskforce Aims To Raise US$1.6 billion For Supplies In Low- and Middle-Income Countries

Guardian - China did 'little' to hunt for Covid origins in early months, says WHO document https://www.theguardian.com/world/2021/feb/23/china-did-little-hunt-covid-origins-early-months- says-who-document

“Summary from visit last year reveals Chinese officials offered scant details.”

13

“… The two-page internal travel report is a summary of the WHO programme manager and mission leader Peter Ben Embarek’s trip to China between 10 July and 3 August 2020, which was described as an advance WHO mission to study the Covid-19 virus and “review work done so far on the origin of the virus”….”

CNN Exclusive: WHO panel to recommend 'deeper' study of early Covid-19 clues https://edition.cnn.com/2021/02/21/china/who-covid-19-origins-intl/index.html

“The World Health Organization's preliminary report into the origins of the novel coronavirus will recommend more extensive contact tracing of the first known patient with Covid-19 in Wuhan, China, as well as the supply chain of nearly a dozen traders in the Huanan seafood market, which is thought to have played a role in the early spread of Covid-19 in late 2019, according to investigators familiar with the draft report…..”

WP (Editorial Board)- Opinion: The U.S. should reveal its intelligence about the Wuhan laboratory https://www.washingtonpost.com/opinions/global-opinions/the-us-should-reveal-its-intelligence- about-the-wuhan-laboratory/2021/02/22/da0e9e90-753f-11eb-9537-496158cc5fd9_story.html

Fair point: “The US possesses classified intelligence information about illnesses in the autumn of 2019, before the global pandemic, at the Wuhan Institute of Virology, or WIV, which was carrying out research on bat coronaviruses very similar in genetic makeup to the pandemic virus. The intelligence should be declassified, and soon. … … Full transparency is needed from China but also from the United States. The intelligence behind Mr. Pompeo’s statements should be declassified, with proper protection for sources and methods. The truth matters, and the United States should not hide any relevant evidence.”

Guardian - Human rights in the time of Covid: 'a pandemic of abuses’, says UN head https://www.theguardian.com/global-development/2021/feb/22/human-rights-in-the-time-of- covid-a-pandemic-of-abuses-says-un-head

“The world is facing a “pandemic of human rights abuses”, the UN secretary general António Guterres has said. Authoritarian regimes had imposed drastic curbs on rights and freedoms and had used the virus as a pretext to restrict free speech and stifle dissent. Writing exclusively in the Guardian, Guterres said the Covid-19 pandemic had rolled back years of progress on human rights, and that abuses had “thrived because poverty, discrimination, the destruction of our natural environment and other human rights failures have created enormous fragilities in our societies”. There has been a global crackdown on opposition activists and human rights defenders, increased attacks on journalists and moves to curb free speech, censor the media, roll out invasive tracking apps and put in place extreme surveillance measures, many of which are likely to far outlast the virus….”

14

AP - Tanzania’s president admits country has COVID-19 problem https://apnews.com/article/pandemics-tanzania-coronavirus-pandemic-east-africa-africa- 7f3aa308d7b117ef6fef77fab0ed7cb0

“Magufuli, speaking at the chief secretary’s funeral in a nationally televised broadcast on Friday, urged the nation to participate in three days of prayer for unspecified “respiratory” illnesses that had become a challenge in the country. … … The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, has added his voice to growing calls for Tanzania to acknowledge COVID-19 for the good of its citizens, neighboring countries, and the world, especially after a number of countries reported that visitors arriving from Tanzania tested positive for the virus. Tedros in a statement on Saturday called Tanzania’s situation “very concerning” and urged Magufuli’s government to take “robust action.” …”

As mentioned by some, it’s not often WHO singles out a country.

Telegraph - Flourishing anti-vax movement threatens to derail immunisation campaigns in Africa Telegraph

“The continent has traditionally been pro-vaccination but false claims - often pushed by prominent politicians - are gaining traction.”

Guardian - All countries must be vaccinated to end pandemic, says World Bank chief https://www.theguardian.com/business/2021/feb/22/all-countries-must-be-vaccinated-to-end- pandemic-says-world-bank-chief

“David Malpass says delivery systems must be improved in poorer nations as world prepares for next crisis.”

Excerpts: “…Serious capacity constraints on vaccination programmes pose the biggest threat to the World Bank’s ambitious goal that all 7 billion people across the globe should be offered Covid-19 protection within a year, its president has said. In an interview with the Guardian, David Malpass said delivery systems in poor countries and the fact that so many vaccines were going to rich countries were more important factors than money in ensuring success. Malpass said beating the pandemic required all countries to be immunised and that the global community should already be preparing for the next crisis…. … An increase in the number of available vaccines would help, Malpass said, but there also needed to be action in poor countries to tackle logistical bottlenecks, to expand healthcare delivery systems and to develop communication strategies to prepare people for vaccine programmes. …. … Malpass said there was a need to accelerate progress on debt relief so that poor countries had more financial firepower to tackle the pandemic. “We need to broaden the definition of sustainable debt and base it on the ability to provide basic health care, education and investments in climate. Resources should be going to things that build for the future. If too big a proportion is going to creditors that undermines sustainability”, he said, urging public and private creditors to sign up to a global debt relief initiative.”

15

WHO manifesto for a healthy recovery from Covid-19 https://www.who.int/docs/default-source/climate-change/who-manifesto-for-a-healthy-and-green- post-covid-recovery.pdf?sfvrsn=f32ecfa7_8v

“Prescriptions and Actionables for a Healthy and Green Recovery”.

“The following WHO prescriptions and accompanied actionables are practical steps for implementing the WHO Manifesto for a healthy recovery from COVID-19. They aim at creating a healthier, fairer and greener world while investing to maintain and resuscitate the economy hit by the effects of COVID-19…. … Six WHO prescriptions, and a comprehensive set of key actionables, for achieving healthier environments is provided accordingly…”

HPW - Global Citizen Launches ‘Recover Better Together’ Campaign https://healthpolicy-watch.news/global-citizen-launches-recover-better-together-campaign-guinea- launches-ebola-vaccinations-nigeria-zambia-studies-show-high-sars-cov2-infections/

“Vaccinating all of Africa’s health workers would need half a percent of all the doses that the G-7 countries have purchased, according to Global Citizen CEO Hugh Evans. On Tuesday, Global Citizen launched a five-point ‘Recover Better Together’ plan for the world, aimed at getting millions of citizens behind ending COVID-19 for all, ending the hunger crisis, resuming learning for children, fully protecting the planet, and advancing equity for all. “First we must focus on achieving sufficient worldwide vaccine coverage to break the chain of transmission, including, for the poorest nations,” Evans told a media briefing convened jointly with the World Health Organization, and addressed by world leaders including European Commission president Ursula von der Leyen, US Special Envoy in Climate John Kerry and South African president Cyril Ramaphosa….”

See also Reuters - EU backs donating COVID-19 shots to African health workers

“European Commission President Ursula von der Leyen on Tuesday supported a call by French President Emmanuel Macron to donate COVID-19 vaccines to health care workers in Africa, as a star-studded event was announced to support equitable distribution. “Vaccines are still scarce everywhere but it is in our common interest to share,” von der Leyen said in a webcast with the World Health Organisation (WHO). “And I therefore support President Macron’s proposal to donate vaccine doses that are necessary to vaccinate health care workers in Africa.”…”

Stat - Backed by Google, epidemiologists launch a sweeping Covid-19 data platform https://www.statnews.com/2021/02/24/global-health-covid19-data-records/

It started as “a spreadsheet, started by a group of international epidemiologists, to collect and openly share granular data on individual Covid-19 cases around the world. Today, that project launched its complete website, Global.health, which will enable open access to more than 5 million anonymized Covid-19 records from 160 countries. Each record can contain dozens of data points about the case, including demographics, travel history, testing dates, and outcomes. The project is supported by $1.25 million in funding and other resources from Google.org, with additional support from the Rockefeller Foundation, and is led by academics from the University of Oxford,

16

Harvard, Northeastern, Boston Children’s Hospital, Georgetown, University of Washington, and Johns Hopkins Center for Health Security. …”

See also Research consortium including Oxford University and Google.org announce new platform to track COVID-19 data.

UN Human Rights Council to call for equitable access to vaccine https://genevasolutions.news/global-health/un-human-rights-council-to-call-for-equitable-access- to-vaccine

“Ecuador plans to call for the equitable and universal access to vaccines in the 46th session of the Human Rights Council, amidst the pandemic that is ravaging countries worldwide.”

“The Geneva-based Human Rights Council is set to take up the pandemic as a human rights issue during its 46th session - building upon debates in sister organizations, such as the World Health Organization and the World Trade Organization. Ecuador has announced that it will be proposing a new HRC resolution calling for equitable vaccine access in response to pandemics and other health emergencies, during the upcoming weeks of the session, which began on Monday. The draft resolution, which Geneva Solutions was able to consult states concerns about measures that have restricted exports of the vaccines, with the proposal requesting the report by the UN high commissioner…”

Reuters – Debilitating 'long-COVID' may have severe health, social impacts: WHO Reuters;

“ Thousands of COVID-19 patients continue to suffer serious, debilitating and lingering symptoms many months after their initial bout of infection, with major social, health and economic consequences, European health experts said on Thursday. Publishing a World Health Organization- led guidance report on the condition, often referred to as “long COVID” or “post-COVID syndrome”, experts said around one in 10 COVID-19 patients are still unwell 12 weeks after their acute infection, and many suffer symptoms for far longer. “This is a condition that can be extremely debilitating. Those suffering from it describe a varying combination of overlapping symptoms... (including) chest and muscle pain, fatigue, shortness of breath ... brain fog (and) many others,” said Martin McKee, a professor at the European Observatory on Health Systems and Policies who led the report. Hans Kluge, the WHO’s European regional director, said long-COVID could have “severe social, economic, health and occupational consequences”.

WHO Policy brief - In the wake of the pandemic: preparing for long Covid.

See also UN News - WHO-backed policy brief calls for action to address ‘long COVID’.

Cidrap News - WHO unveils pandemic game plan https://www.cidrap.umn.edu/news-perspective/2021/02/european-countries-battle-more-covid- 19-flare-ups

17

“The WHO yesterday posted its Strategic Preparedness Response Plan documents, which detail its plan for battling COVID-19 this year. Last week, the group's director-general said $1.96 billion is needed to meet the plan's six goals, which range from driving down virus transmission to countering misinformation to ensuring equitable access to vaccine….”

And some links:

HPW - The European Medicines Agency’s COVID-19 Vaccine Leaks: Hacks, Regulatory Pressures And Manufacturing Concerns

Reuters - Moderna sees $18.4 billion in sales from COVID-19 vaccine in 2021

Covid science

BMJ (News) - Covid-19 will become endemic but with decreased potency over time, scientists believe https://www.bmj.com/content/372/bmj.n494?utm_source=twitter&utm_medium=social&utm_ter m=hootsuite&utm_content=sme&utm_campaign=usage

“The SARS-CoV-2 coronavirus will not be eradicated but will become endemic, continuing to circulate in pockets of the global population for years to come and causing outbreaks in regions where it had been eliminated, scientists working in the field believe.”

WEF - COVID-19: what happens if some countries don’t vaccinate? A Kalebi; https://www.weforum.org/agenda/2021/02/covid-19-equal-vaccine-nationalism- government-public-health/

“The pandemic can only be contained if every population has equal access to vaccines, which will prevent the virus from mutating. …. …” Vaccination must be treated as a global issue, or no one will be truly be safe.”

“In countries where no significant proportion of the population is vaccinated, there is a huge risk of sustained community spread of COVID-19 over a prolonged period. The longer the period of sustained community spread, the more likely that the virus will mutate. And this means it could be a breeding ground for the new coronavirus – SARS-CoV-2 – to mutate into more aggressive variants. The mutated variants from the unvaccinated population will be able to infect even those in the vaccinated population….”

Nature - Why COVID vaccines are so difficult to compare https://www.nature.com/articles/d41586-021-00409- 0?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews

18

“Despite the widespread roll-out of several vaccines, it could be months before they can be ranked.”

“Given the demand for speed amid limited supplies, any effort to rank the vaccines must take into account not only their reported effectiveness, but also supplies, costs, the logistics of deploying them, the durability of the protection they offer and their ability to fend off emerging viral variants. Even so, many people might find it hard to look away from clinical-trial results that suggest an efficacy gap … … … And the vaccines were studied at different times in various countries. Each trial can only offer a snapshot of protection against the viral variants that were dominant in that time or place, says Kennedy. “That number relates to a particular point in time,” he says. “How that translates into protection over one to two years is not the same.”….”

Guardian - One vaccine dose gives high protection from severe Covid, evidence shows https://www.theguardian.com/world/2021/feb/22/one-vaccine-protection-severe-covid-evidence

“First real data from mass vaccinations programmes in England and Scotland is promising…” (both for Pfizer & AstraZeneca vaccines)

“The first real data from the mass vaccination programmes is promising, and although the results do not include evidence that they prevent transmission completely, there is data to show they are stopping some people becoming infected, which should slow the spread of coronavirus. Three studies came to similarly positive conclusions about the protection offered by the vaccines – one in Scotland and two in England – although they were set up to look at the effects in different groups of people….”

Nature (News) - How ‘killer’ T cells could boost COVID immunity in face of new variants Nature;

“In the race against emerging coronavirus variants, researchers are looking beyond antibodies for clues to lasting protection from COVID-19.”

Nature News - Can COVID vaccines stop transmission? Scientists race to find answers https://www.nature.com/articles/d41586-021-00450-z

“Controlling the pandemic will require shots that prevent viral spread, but that feature is difficult to measure.”

WSJ - In Hunt for Covid-19 Origin, WHO Team Focuses on Two Animal Types in China https://www.wsj.com/articles/in-hunt-for-covid-19-origin-who-team-focuses-on-two-animal-types- in-china-11613665015?reflink=desktopwebshare_twitter

19

“Investigators say ferret badgers and rabbits sold at Wuhan market could have played a role in the spread to humans.”

Nature (News) - Superspreading drives the COVID pandemic — and could help to tame it https://www.nature.com/articles/d41586-021-00460-x

“Uneven transmission of the SARS-CoV-2 coronavirus has had tragic consequences — but also offers clues for how best to target control measures.”

Telegraph - Coronavirus cases are falling globally, but the big question is: why? Telegraph;

“ For the sixth consecutive week infections have plummeted worldwide. Our Global Health team looks at what might explain the fall in cases.” It’s a mix of reasons, apparently.

And some links:

Guardian - Nigeria survey suggests 23% of Lagos residents had Covid last year

Stat - FDA scientists endorse J&J’s Covid vaccine, as new data shed light on efficacy

Stat - Moderna ready to test version of Covid-19 vaccine aimed at worrisome variant

NYT - A New Coronavirus Variant Is Spreading in New York, Researchers Report

“The variant contains a mutation thought to help the virus dodge the immune system, scientists said.”

Reuters - In boost for COVID-19 battle, Pfizer vaccine found 94% effective in real world

See also Stat - Pfizer-BioNTech vaccine performs as well in the real world as in clinical trials, new study concludes.

Covid vaccine access

With updates on COVAX, the TRIPS Waiver proposal, vaccine diplomacy and much more.

Reuters - First COVID-19 vaccine doses dispatched by COVAX arrive in Ghana https://www.reuters.com/article/uk-health-coronavirus-ghana-vaccines-idUSKBN2AO0NZ

20

“The World Health Organization’s global vaccine sharing scheme COVAX delivered its first COVID- 19 shots on Wednesday … …. A flight carrying 600,000 doses of the AstraZeneca/Oxford vaccine produced by the Serum Institute of India landed in Ghana’s capital Accra, the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF), said in a joint statement. The delivery comes almost a year after the WHO first described the novel coronavirus as a global pandemic and eight months after the launch of the COVAX initiative…”

“The shipments also represent the beginning of what should be the largest vaccine procurement and supply operation in history. The COVAX Facility plans to deliver close to 2 billion doses of COVID- 19 vaccines this year….”

“The government said on Friday that the first tranche will be used to kick start the country’s vaccination drive, which prioritises frontline health workers and those most vulnerable to severe disease….”

WHO press release - COVID-19 vaccine doses shipped by the COVAX Facility head to Ghana, marking beginning of global rollout

“Beginning of global rollout means that, as readiness criteria are met and doses produced, vaccines will be shipped to Facility participants on a rolling basis…”

• See also the Washington Post – First vaccine doses distributed by Covax landing in West African nation of Ghana

"The West African country of 31 million was selected as the first recipient after sending a rollout plan to Covax proving its health-care teams and cold chain equipment were ready to support a quick distribution."…”

• See also Cidrap News - COVAX vaccine begins shipping from India facility

“In the push for a broad global rollout of COVID-19 vaccine, the first batches of AstraZeneca-Oxford vaccine made in India today began shipping to countries that are part of COVAX, a program to support the development of vaccines and ensure their equitable distribution. WHO’s South East Asia office said on Twitter today that the first batches rolled out from India's Serum Institute in Pune. … … India's external affairs ministry spokesman Anurag Srivastava said the first shipments are bound for countries in Africa, according to CNN. …”

And via HPW - Ambitious Global COVAX Facility Delivers First Doses

Africa CDC’s reaction: “John Nkengasong described the first deliveries as “an important step towards our continental goal of immunising at least 60% of Africa’s population with safe and efficacious vaccines against COVID-19.” … The African Union (AU) has been trying to help its 55 member states buy more doses in a push to immunize 60% of the continent’s 1.3 billion people over three years. To that end it has so far secured some 670 million doses of the AstraZeneca, Pfizer and Johnson & Johnson vaccines – in addition to the COVAX supplies of some 90 million doses to the continent. China has donated small batches of its Sinopharm vaccine to countries including Zimbabwe and Equatorial Guinea. And Russia has offered to supply 300 million doses of its Sputnik V vaccine to the AU scheme along with a financing package….”

21

“Expect More African Pressures On COVAX to Roll Out Johnson & Johnson”: “ The J&J approval will pave the way for the COVAX facility to begin rolling out that vaccine too. And in African countries like Ghana, faced with creeping vases of the variant – there may be growing pressures to swap out AstraZeneca for J&J doses. J&J has already committed to provide 500 million doses of its vaccine through the global COVAX facility – in addition to the deals made through the AU. …”

Stat - New pledges boost COVAX, but critics say more is needed to ensure global vaccine access https://www.statnews.com/pharmalot/2021/02/22/covid19-coronavirus-vaccine-who-covax-pfizer- jnj-moderna-astrazeneca/

Recommended analysis. Current state of affairs re Covax ( as of last weekend, after the G7 summit).

Excerpts: “After months of uncertainty and frustration, a World Health Organization program designed to ensure access to Covid-19 vaccines in dozens of low-income countries late last week received a spate of good news. First, one vaccine maker, Novavax (NVAX), pledged 1.1 billion doses of its shot to the WHO effort, which is known as COVAX. Meanwhile, the U.S. agreed to contribute $4 billion in aid over the next two years, with Germany adding $1.2 billion and the European Commission providing $600 million. Collectively, the G7 countries have now committed a total $7.5 billion. And the U.K. promised to provide surplus vaccines to low-income countries. The sudden rush of announcements was in stark contrast to increasing concerns that COVAX was faltering.

…. But despite the obvious signs of progress, questions remain about the extent to which the effort, known as COVAX, can succeed. For the moment, supply is constrained. COVAX expects 336 million doses from AstraZeneca and 1.2 million doses from Pfizer to cover just 3.3% of the population of the 145 countries participating in the program.;..”

“In terms of financing, the gaps are starting to be plugged, but the key issue is transparency,” said Manuel Martin, a medical innovation and policy advisor for the access campaign run by Doctors Without Borders. “The manufacturers are offering doses but under what terms, we have no idea, yet the agreements are moving forward and there is not enough information to exert pressure.” A key issue, he continued, is a need to support technology transfer, which refers to providing knowledge to other companies so that vaccine manufacturing can be accelerated. This argument has gone hand-in-hand with calls to temporarily waive provisions in a World Trade Organization agreement in hopes of making Covid-19 medical products more easily accessible, especially by low- income economies….”

Reuters - Philippines offers nurses in exchange for vaccines from Britain, Germany

Reuters;

Our nasty global economic system never fails to disappoint even more.

22

“The Philippines will let thousands of its healthcare workers, mostly nurses, take up jobs in Britain and Germany if the two countries agree to donate much-needed coronavirus vaccines, a senior official said on Tuesday….”

A reaction: “… “We are disgusted on how nurses and healthcare workers are being treated by the government as commodities or export products,” Jocelyn Andamo, secretary general of the Filipino Nurses United, told Reuters.”

The bureau of investigative journalism - ‘Held to ransom’: Pfizer demands governments gamble with state assets to secure vaccine deal https://www.thebureauinvestigates.com/stories/2021-02-23/held-to-ransom-pfizer-demands- governments-gamble-with-state-assets-to-secure-vaccine-deal

In the same category, this one on the marvels of Big Pharma “best practices”: “Pfizer has been accused of “bullying” Latin American governments in Covid vaccine negotiations and has asked some countries to put up sovereign assets, such as embassy buildings and military bases, as a guarantee against the cost of any future legal cases, the Bureau of Investigative Journalism can reveal. … … Pfizer has been in talks with more than 100 countries and supranational organisations, and has supply agreements with nine countries in Latin America and the Caribbean: Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, Peru, and Uruguay. The terms of those deals are unknown…..”

Kei - Manufacturers of COVID-19 vaccines typically start delivering in under six months after tech transfer

L G Abinader; https://www.keionline.org/35364

“Based on press releases and additional publicly-available information, KEI is building a dataset with a non-exhaustive list of deals that involve technology transfer and outsourcing of COVID-19 vaccines manufacturing. As of February 19, 2021, the dataset includes observations for over 70 outsourcing and technology transfer deals done since the start of the pandemic until present. We will continue to add deals and data points. The current version of this dataset, which is still a work in progress, is available here. The dataset includes a diverse list of companies, platforms, and manufacturing steps. In most of the cases where information is publicly available, delivery of the first batches started in under six months after the technology transfer began. Our dataset shows that companies with pre-existing drug and vaccine manufacturing capabilities can start producing COVID-19 vaccines relatively quickly, if technology transfer is made….”

Geneva Health Files - WTO TRIPS Council formal meeting: deadlock remains Geneva Health Files; On the meeting on 23 Feb: “ Countries continued to remain deadlocked in their positions on the discussions on the TRIPS Waiver proposal at a formal meeting of the TRIPS Council today at the WTO.”

PS: The proponents now have the support from the African Group as co-sponsors to the proposal.

23

TWN – Two-thirds of WTO members issue call for a TRIPS waiver https://www.twn.my/title2/health.info/2021/hi210208.htm In-depth coverage of the meeting on 23 Feb: “…more than two-thirds of the World Trade Organization’s 164 members have issued a clarion call to support the proposed temporary TRIPS waiver to combat the COVID-19 pandemic by ramping up production of diagnostics, therapeutics and vaccines to ensure equitable and affordable access worldwide, negotiators told the SUNS.”

Reuters - African Union backs call to waive IP rights on COVID-19 drugs Reuters; “The African Union is backing calls for drugmakers to waive some intellectual property rights on COVID-19 medicines and vaccines to speed up their rollout to poor countries, the head of its disease control body said on Thursday. … South-Africa & India have faced opposition from some developed nations, but the backing of the African Union (AU) may give renewed impetus for the push to relax IP rules. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, told a news conference that IP transfer was a “win-win for everybody” that would address the huge inequalities in global public health….”

And a few links:

The Conversation - Intellectual property and COVID-19 medicines: why a WTO waiver may not be enough (by E Bonadio et al)

MSF Access - MSF calls on European Council to enable global production of COVID-19 medical tools

“Ahead of a European Council meeting on 25-26 February, Médecins Sans Frontières/Doctors Without Borders (MSF) urged the European Union (EU) to take urgent action to promote greater global access to COVID-19 vaccines and other lifesaving health technologies. For equitable distribution of all COVID-19 medical tools, the EU must stop blocking the intellectual property (IP) waiver proposal at the World Trade Organization (WTO) and facilitate transfer of health and vaccine technologies by pharmaceutical corporations in Europe to manufacturers in low- and middle- income countries….”

TWN - US lawmakers urge Biden to support TRIPS waiver proposal at WTO https://www.twn.my/title2/intellectual_property/info.service/2021/ip210205.htm

For the moment, the Biden Administration remains firmly focused on COVAX (and ACT-A) – just like the Germans, to show global solidarity. So not much moving on TRIPS from these fellows for the moment, unfortunately.

PS: do check out also this paragraph: (WTO) DG’S praise for pharmaceutical companies

“… Ms Ngozi showered praise on “some pharmaceutical companies”, saying that they “are already ahead of the game because they are doing this.” She said that “Astrazeneca has licensed production

24

in several countries, and has recently declared that it is willing to look at more such arrangements.” According to Mr Da Gama, Astrazeneca is charging double the price paid by the European companies in South Africa. However, the new DG went on to support Big Pharma, saying that “Johnson & Johnson seems willing to follow suit looking beyond contract manufacturing to licensing agreements. The Serum Institute of India, which is set [up] to manufacture up to 1 billion doses of vaccines, is a good example.” “Facilitating such arrangements will enable the WTO to support the WHO ACT- Accelerator, especially the COVAX facility to get affordable vaccines quickly to poor countries,” the new DG said. “Looking beyond this pandemic, the WTO must be proactive in strengthening cooperation with other multilateral and bilateral partners, the private sector, and civil society to set a framework for dealing with problems of the global commons such as this pandemic,” she said. Ms Ngozi’s silence on the TRIPS waiver caused alarm among the supporters of the waiver. “It’s disturbing that even without assuming office, she chose to extend her support to controversial initiatives while ignoring the TRIPS waiver that is being supported by around 100 countries,” said a TRIPS negotiator, who asked not to be quoted….”

“It remains to be seen what she might say when the issue comes up for discussion at the General Council meeting on 1 March.”

Paper - WTO Waiver from Intellectual Property Protection for COVID-19 Vaccines and Treatments: A Critical Review B Mercurio; https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3789820

Pre-print. The first academic publication (to our knowledge) that seems to have some reservations about the TRIPS waiver proposal. “…This article reviews the justifications put forward for the proposal before presenting counterarguments that the waiver is unnecessary, would not alleviate the burden of access to effective and affordable medicines and vaccines and could potentially hamper R&D and innovation in the pharmaceutical sector.”

I Borowy: Covid-19 Vaccines – On Fairness and Distribution http://www.peah.it/2021/02/covid-19-vaccines-on-fairness-and-distribution/

“There is a widespread feeling that the ongoing system of distribution of Covid-19 vaccines is underperforming and unfair. But just what could a realistic and fair system look like? Which conceptual, practical or moral criteria should be used? Who should decide? This paper reviews recent developments and considers the arguments for possible pathways.”

Respectively: Donate extra doses when domestic need has been (partially) satisfied; Donate/sell unilaterally; Strengthen Covax; Suspend patents / provide free licenses.

BBC - Covid-19: Which countries in Africa are administering vaccines? https://www.bbc.com/news/56100076

As of a few days ago: “Currently, in North Africa, these are the countries vaccinating (and the vaccines being used): Morocco (AstraZeneca and Sinopharm); Algeria (Sputnik V); Egypt (Sinopharm). In sub-Saharan Africa, the countries vaccinating are: South Africa (Johnson & Johnson); Seychelles

25

(Sinopharm and AstraZeneca); Rwanda (reportedly using Pfizer and Moderna); Mauritius (AstraZeneca); Zimbabwe (Sinopharm). Others such as Senegal and Equatorial Guinea have had their first deliveries - of Sinopharm - but have yet to begin giving them to the general public….”

Thomson Reuters - Insecurity, suspicion will mar vaccine rollout in Africa war zones https://news.trust.org/item/20210219094920-3uq3r/

From last week (in the margins of the UN Security Council meeting): “A feeling the vaccine is not a priority, suspicion of taking a "foreign" drug and the threat of attacks by militants are just some of the challenges health workers will face getting vaccines to millions in Africa's conflict zones, say charities.”

“160 million people are at risk of being excluded from coronavirus vaccinations due to conflict; Britain is calling for ceasefires to roll out vaccines in conflict zones; There were 1,200 attacks on health workers, medical facilities and vehicles in 20 countries in conflict in 2019.”

Reuters - India's Serum Institute says prioritising domestic vaccine needs, asks for patience

Reuters;

This was ominous news last weekend: “Serum Institute of India (SII), the world’s biggest vaccine maker by volume, on Sunday asked for patience from foreign governments awaiting their supply of COVID-19 shots, saying it had been directed to prioritise India’s requirements….”

Geneva Health Files - Constraints facing the COVID-19 Technology Access Pool (C- TAP) P Patnaik; Geneva Health Files;

Must-read analysis which tries to examine the reasons that are holding back the WHO COVID-19 technology access pool. “Our view is that it is not the inequitable access to vaccines, but production concerns in Europe which may well be a catalyst setting into motion a domino effect pushing the C- TAP into action….”

With lots of info on how C-TAP will run in practice, its governance, etc.

As a reminder, see also the WHO concept paper on C-TAP: https://www.who.int/publications/m/item/c-tap-a-concept-paper

Reuters - African Union says Russia offers 300 million doses of Sputnik V vaccine

Reuters;

26

“The African Union’s (AU) vaccine task team said [last week] on Friday that Russia had offered it 300 million doses of its Sputnik V COVID-19 vaccine along with a financing package for countries wanting to secure the shots…. “

FT - Africa paying more for Russian Covid vaccine than ‘western’ jabs FT;

“The African Union will pay three times more for Russia’s Sputnik V jab than it is paying for the Oxford/AstraZeneca and Novavax vaccines, according to people familiar with the procurement process. The $9.75 price per dose for 300m shots of the Russian vaccine, developed by the state-run Gamaleya Institute, undermines Moscow’s argument that it is offering affordable jabs to countries priced out of deals with western pharmaceutical groups….”

Devex - In Brief: Over half of African nations to start COVID-19 vaccine rollouts in coming weeks https://www.devex.com/news/in-brief-over-half-of-african-nations-to-start-covid-19-vaccine- rollouts-in-coming-weeks-99252

“More than half the countries on the African continent are expected to roll out COVID-19 vaccine campaigns in the coming weeks, according to World Health Organization Africa Regional Director Dr. Matshidiso Moeti. … 24 African nations have laid the groundwork for vaccine shipments through the [Covax ] facility in the coming weeks, Moeti said during a press conference, after finalizing pre-shipment arrangements. This includes finalizing national vaccination deployment plans, approving import permits, and signing indemnity and liability agreements with vaccine manufacturers, said Dr. Richard Mihigo, immunization and vaccine development program coordinator for the WHO Regional Office for Africa….”

“…In addition to vaccines secured through the COVAX Facility, the African Union has also procured vaccines and some countries have made bilateral arrangements to gain access to vaccines independently. African countries that have started vaccinations without the help of the facility include South Africa, Senegal, Morocco, Egypt, Seychelles, and Guinea, said John Nkengasong, director at the Africa Centres for Disease Control and Prevention.”

Reuters - Johnson & Johnson applies to WHO for emergency use listing of COVID- 19 vaccine Reuters;

“Johnson & Johnson said [last week] on Friday it had submitted data to the World Health Organization (WHO) for emergency use listing of its COVID-19 vaccine, which would allow for wider access of the one-dose shot….

Politico- China winning vaccine diplomacy battle, but will lose the war https://www.politico.com/newsletters/global-translations/2021/02/24/china-winning-vaccine- diplomacy-battle-but-will-lose-the-war-491881

27

(24 Feb) Politico has the overview on all “vaccine diplomacy” ongoing, from various sides: Covax, China, India, Russia, UAE, ..

“Vaccine donations …. have so far been dominated by China and Russia, despite the two countries producing only around 10 percent of available vaccines”. But that’s about to change.

“…The first vaccine deliveries through the global COVAX project arrived this morning in Accra, Ghana, to be followed by deliveries to Maldives and Cote D’Ivoire, with jabs starting on Monday. Henrietta Fore, executive director of UNICEF, which procured the vaccines, called it a “historic moment” for vaccine equity. If nothing else, the deliveries mark a turning point in vaccine diplomacy. Vaccine donations have so far been dominated by China and Russia, despite the two countries producing only around 10 percent of available vaccines, whereas COVAX receives more than 95 percent of its funds from the G7 and EU institutions. … … The Western and COVAX scale advantage: The Colombia case shows China winning now, and COVAX helping more in the long run. The dynamic will be repeated in at least 20 countries whose sole supplies until now have come from China and Russia, but who are due to get COVAX supplies. …”

Economist - China’s roll-out of covid-19 vaccines is slower than planned https://www.economist.com/china/2021/02/20/chinas-roll-out-of-covid-19-vaccines-is-slower-than- planned

“Production bottlenecks and a perceived lack of urgency don’t help.”

Chatham House (Expert Comment) - Beijing’s Vaccine Diplomacy Goes Beyond Political Rivalry

T H El Kadi et al ; https://www.chathamhouse.org/2021/02/beijings-vaccine-diplomacy-goes- beyond-political-rivalry

“China has been accused of using its vaccine to expand its influence, but for many struggling economies it is filling a gap left by Western states and donors.”

Focus in this analysis on the MENA region.

FT – India turns to private sector to boost sluggish Covid-19 vaccine drive https://www.ft.com/content/0d5a169b-c85e-4f1d-a326-64cf82bbdb0f

“…At the current pace of around 400,000 jabs a day, India would need four years to cover the first batch of 300m Indians — health workers, frontline workers and the elderly — targeted for vaccination by August. Most states offer Covid-19 inoculations only a few days each week. Overloaded state health workers have so much else to do, including catching up on routine childhood immunisations, which came to a halt in last year’s lockdown. But the vaccination drive looks set to gain new momentum after Narendra Modi’s government decided on Wednesday to let private hospitals start providing the jabs to those who can pay for them. From next week, Indians over age 60, and those over 45 with health problems that raise risks of severe Covid, can go to up to 20,000

28

private hospitals or 10,000 government-run vaccination centres. While the government will give out jabs free, those vaccinated privately in hospitals will be charged, with New Delhi to fix the price in the coming days….”

HPW - India Moots Regional Pandemic Platform with 10 Neighbours https://healthpolicy-watch.news/india-pandemic-platform/

“After donating over 6 million Covid vaccines to more than 13 countries, the Indian government suggested the creation of a regional pandemic platform for preparedness and medical emergencies with its 10 neighbouring countries. At a meeting with health officials, Indian Prime Minister Narendra Modi proposed creating “a special visa scheme” for doctors and nurses to enable swift travel during health emergencies,coordinated air ambulances, a regional platform for “collating, compiling and studying data about the effectiveness of Covid-19 vaccines” and a network for “promoting technology-assisted epidemiology for preventing future pandemics.”…”

Nairobi News - Private companies to import Covid-19 vaccines https://nairobinews.nation.co.ke/editors-picks/private-companies-to-import-covid-19-vaccines

In Kenya, “The Health Ministry will allow some private pharmaceutical companies to import coronavirus vaccines to compliment government efforts. According to the ministry, discussions are underway with the Pharmacy and Poisons Board (PPB) to issue the companies a conditional market authorisation in a bid to bridge access gap and increase the number of doses in the country….”

Reuters - Israel sharing some COVID vaccines with Palestinians, Honduras, Czech Republic Reuters;

“Israel said on Tuesday it was giving small amounts of surplus COVID-19 vaccines to Palestinian-run territories as well as to several countries….”

WSJ - To Make More Covid-19 Vaccines, Rival Drugmakers Team Up https://www.wsj.com/articles/to-make-more-covid-19-vaccines-rival-drugmakers-team-up- 11614081601

“Sanofi and Novartis are among the big pharmaceutical companies that have agreed to help make a competitor’s shots…”

“… … More companies may follow. Merck, a pioneer in vaccines, is in discussions with companies about lending its expertise after scrapping two Covid-19 vaccine programs with lackluster results. Teva Pharmaceutical Industries Ltd. is holding similar discussions.”

29

Politico - Poorer countries hit with higher price tag for Oxford/AstraZeneca vaccine https://www.politico.eu/article/astrazeneca-vaccine-cost-higher-in-poorer-countries-coronavirus/

“Bangladesh, South Africa and Uganda all appear set to pay more for the vaccine than the EU.”

See also NPR - Price Check: Nations Pay Wildly Different Prices For Vaccines

“Why does a dose of the Oxford-AstraZeneca vaccine cost $8.50 in Uganda and $4 in the U.S.? Our correspondent @jasonbnpr looks into why nations are paying wildly different prices for vaccines.” With a very telling table of the variability of pricing for the AstraZeneca vaccine.

Daily Start - Covid-19 Vaccine: Only a third of the recipients women https://www.thedailystar.net/frontpage/news/covid-19-vaccine-only-third-the-recipients-women- 2047253

In Bangladesh.

Nature – Rich countries should tithe their vaccines Gavin Yamey; https://www.nature.com/articles/d41586-021-00470-9

“Game theory suggests that donating doses can help nations of all income levels.” See the related BMJ Global Health publication from a while ago.

“… To help, rich countries should tithe their vaccine supply to poorer places and negotiate direct purchasing deals with vaccine manufacturers to increase supplies. … Richer nations should share their doses, stat. Perhaps for every nine doses they administer, they can donate one dose to COVAX. This falls far short of ‘equitable’, but it is within what is possible. My colleagues and I used game theory to project what would happen if rich nations reconfigured their purchasing deals to increase the global vaccine supply (D. McAdams et al. BMJ Glob. Health 5, e003627; 2020). Currently, each vaccine purchase is a zero-sum game. But deals could include provisions that require vaccine makers to share knowledge and technology to boost production by other manufacturers. As a real-world example, the Serum Institute of India can manufacture the AstraZeneca–University of Oxford vaccine, providing doses for low- and middle-income countries….”

Interesting proposal. But I guess there are other ways to ensure that “global vaccine distribution is no longer a zero-sum game”…

BMJ GH – An intersectional human rights approach to prioritising access to COVID-19 vaccines S Sekala et al ; https://gh.bmj.com/content/6/2/e004462

30

“…In this paper, we argue that the practical implementation of human rights law requires broader consideration of intersectional needs in society and the disproportionate impact that COVID-19 is having on population groups with pre-existing social and medical vulnerabilities. The existing frameworks/mechanisms and proposals for COVID-19 vaccine allocation have shortcomings from a human rights perspective that could be remedied by adopting an intersectional allocative approach. This necessitates that states allocate the first COVID-19 vaccines according to (1) infection risk and severity of pre-existing diseases; (2) social vulnerabilities; and (3) potential financial and social effects of ill health. …”

BMJ GH (Commentary) - How to ensure a needs-driven and community-centred vaccination strategy for COVID-19 in Africa Yap Boum, E Torreele et al ; https://gh.bmj.com/content/6/2/e005306

“… Uniform thinking and planning overlook distinct country realities that may imply different COVID-19 responses, including vaccination strategies, and that local stakeholders and communities have a central role in designing and implementing successful public health interventions. The distribution of COVID-19 vaccines should be part of an integrated and broader strategy, both to curb COVID-19 and also to improve life and well-being of the target community. The backdrop of Africa in the COVID-19 vaccine race highlights the urgency for Africans to invest in research to ensure that strategies are adapted to the Africa context and not just imported as the COVID-19 vaccine will be….”

Telegraph - Why the world’s poorest are falling behind in the global vaccines arms race Telegraph;

“ It's not just inequity hampering developing countries access to jabs: logistical challenges, corruption and conflict are also to blame.” Helicopter view of the world, in terms of challenges.

And some links:

Reuters - France's Sanofi to help Johnson & Johnson manufacture COVID-19 vaccine

Covid analysis

Lancet Offline – Offline: Thinking the pandemic https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00514-6/fulltext

“An emergency such as COVID-19 demands more—moments to think about what this pandemic means for us, to ask questions about its deeper impacts on our lives, and to reflect on its consequences for our future. Philosophers, not scientists, might be of more use to us if we are seeking informed contemplation. And a few are now thinking the pandemic. Slavoj Žižek was one of

31

the first philosophers to write about COVID-19. In Pandemic! COVID-19 Shakes the World, he offered some provisional predictions. …”

“…whether Žižek is right or wrong is immaterial. What matters is that he is asking questions that should be central to our public discussion about the pandemic and our post-pandemic future. Yet they are not.”

World Development - Post-pandemic transformations: How and why COVID-19 requires us to rethink development M Leach et al; https://www.sciencedirect.com/science/article/pii/S0305750X20303600

“COVID-19 is proving to be the long awaited ‘big one’: a pandemic capable of bringing societies and economies to their knees. There is an urgent need to examine how COVID-19 – as a health and development crisis - unfolded the way it did it and to consider possibilities for post-pandemic transformations and for rethinking development more broadly. Drawing on over a decade of research on epidemics, we argue that the origins, unfolding and effects of the COVID-19 pandemic require analysis that addresses both structural political-economic conditions alongside far less ordered, ‘unruly’ processes reflecting complexity, uncertainty, contingency and context-specificity. This structural-unruly duality in the conditions and processes of pandemic emergence, progression and impact provides a lens to view three key challenge areas. The first is how scientific advice and evidence are used in policy, when conditions are rigidly ‘locked in’ to established power relations and yet so uncertain. Second is how economies function, with the COVID-19 crisis having revealed the limits of a conventional model of economic growth. The third concerns how new forms of politics can become the basis of reshaped citizen-state relations in confronting a pandemic, such as those around mutual solidarity and care. COVID-19 demonstrates that we face an uncertain future, where anticipation of and resilience to major shocks must become the core problematic of development studies and practice. Where mainstream approaches to development have been top down, rigid and orientated towards narrowly-defined economic goals, post-COVID-19 development must have a radically transformative, egalitarian and inclusive knowledge and politics at its core.”

BMJ (Editorial) - Covid-19 in Africa J Tembo; https://www.bmj.com/content/372/bmj.n457

“Evidence of possible under-reporting of SARS-CoV-2 in Zambia.” Editorial linked to a new study in BMJ.

New Yorker - Why Does the Pandemic Seem to Be Hitting Some Countries Harder Than Others?

S Mukherjee; New Yorker

Recommend ‘helicopter view’ long read. “While the virus has ravaged rich nations, reported death rates in poorer ones remain relatively low. What probing this epidemiological mystery can tell us about global health.”

32

“… For many statisticians, virologists, and public-health experts, the regional disparities in covid-19 mortality represent the greatest conundrum of the pandemic….”

“… What researchers have described to me as the pandemic’s most perplexing feature may turn out to be the epidemiological version of that mystery on the Orient Express: there’s no one culprit but many. With respect to the raw numbers, underreporting is an enormous problem; differences in age distribution, too, make a very deep cut, and perhaps the models must further calibrate their weightings here. Plainly, certain countries have benefitted from the strength of their public-health systems, fortified by a vigorous government response. (Our country has suffered grievously from corresponding weaknesses.) In New Zealand, raising the drawbridges and stringently enforcing quarantines made all the difference. But to come to grips with the larger global pattern we have to look at a great many contributing factors—some cutting deeper than others, but all deserving attention….”

Developing Countries Struggling To Cope With COVID-19 A Chowdury et al; https://www.ksjomo.org/post/developing-countries-struggling-to-cope-with- covid-19

On the non-health impact. “The ongoing COVID-19 pandemic is adversely impacting most developing countries disproportionately, especially the United Nations’ least developed countries (LDCs) and the World Bank’s low-income countries (LICs). Years of implementing neoliberal policy conditionalities and advice have made most developing countries much more vulnerable to the COVID-19 pandemic by undermining their health systems and fiscal capacities to respond adequately….”

CGD (blog) - Who Gets a COVID-19 Vaccine and Who Pays? The Need for Economic Analysis https://www.cgdev.org/blog/who-gets-covid-19-vaccine-and-who-pays-need-economic- analysis#.YDVpY3n0IJQ.twitter

Must-read!!!!! “In 2020, epidemiological modelling went from relative obscurity to being central in helping governments, and the public, understand COVID-19 as it spread around the world. In 2021, with the emergence of effective COVID-19 vaccines, Health Technology Assessment (HTA) will be critical to making the best possible decisions in bringing the pandemic under control, particularly in low-and middle-income countries (LMICs). In this blog we look at the potential of HTA to inform how much vaccine countries should buy, who should pay, and how vaccines can be most effectively delivered….”

Quote: “COVAX, the initiative to support COVID-19 vaccination in LMICs involving WHO, Gavi, CEPI, and UNICEF, has committed to provide sufficient doses for at least 20 percent coverage in participating countries. While the potential efficacy of vaccines against transmission (rather than clinical outcomes) will begin to emerge over the coming weeks, the coverage required to bring the reproductive number below one in absence of physical distancing measures will differ between countries and is very likely to be greater than 20 percent. Africa CDC is currently working with member states of the African Union towards a goal of 60 percent coverage and estimate it could cost as much as $7-10 billion for the vaccine and the systems and structures required for

33

delivery. On a continent where per capita annual health expenditure can be as little as $30, care should be taken to be sure resources are used in the best way….”

Telegraph - Covid-19 has ended a decade of progress in school nutrition, WFP says Telegraph;

“Schools play a major part in providing comprehensive health and nutritional interventions across the globe. “ “The pandemic "ended a decade of growth for school meals programmes", according to the State of School Feeding Worldwide report from the World Food Programme and academics at the London School of Hygiene and Tropical Medicine. “

Lancet Psychiatry Review - COVID-19 mental health impact and responses in low- income and middle-income countries: reimagining global mental health https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00025-0/fulltext

“…. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high- income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. ….”

Critical Public Health - Rethinking disease preparedness: incertitude and the politics of knowledge M Leach et al; https://www.tandfonline.com/doi/full/10.1080/09581596.2021.1885628?src=

“This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk – where future outcomes can be predicted – and fail to address uncertainty, ambiguity and ignorance – where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an

34

approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.”

Lancet Infectious Diseases (Editorial) - The COVID-19 exit strategy—why we need to aim low https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00080-3/fulltext

Tu quoque, Lancet Infectious Diseases ? Advocating for ‘(near) zero Covid’, it seems.

“…This strategy would require a global, coordinated response—so far absent from the pandemic—but if achieved would reap benefits. WHO is well positioned to lead such as response; however, to be successful, an elimination strategy will require individual governments to look beyond their own interests and commit to zero COVID.”

Covid resources

Graduate Institute COVID-19 Vaccine Purchasing & Manufacturing Arrangements https://www.knowledgeportalia.org/covid19-vaccine-arrangements

“We have been tracking publicly available data on agreements to manufacture, purchase, supply and/or donate Covid-19 vaccines in order to shed light on who is likely to have access to which vaccines, from whom, and when. A selection of graphics representing the data are presented below; the full dataset is available for download here, along with its associated README file….”

IDS - Visualising the world’s response to Covid-19 through online trackers

D Battacharya et al ; https://www.ids.ac.uk/opinions/visualising-the-worlds-response-to-covid-19- through-online-trackers/

“…Researchers at the Political Settlements Research Programme (PSRP) at the University of Edinburgh and partners in the Covid Collective research platform, have been tracking the nexus between conflict, peace, and Covid-19 since the beginning of the pandemic. To help inform peace and conflict research at a time of rapid and often unparalleled change, PSRP has developed the Covid-19 Library of Trackers, a curated selection of trackers that trace developments during Covid- 19 in a wide variety of areas – such as border controls, human rights and freedom of speech – which may impact peace and conflict processes across the globe….

35

Ebola

HPW - Guinea Launches Ebola Vaccinations https://healthpolicy-watch.news/global-citizen-launches-recover-better-together-campaign-guinea- launches-ebola-vaccinations-nigeria-zambia-studies-show-high-sars-cov2-infections/

“Guinea started Ebola vaccinations on Tuesday of people at high risk in Gouecke, a rural community in N’Zerekore prefecture where the first cases were detected on 14 February – the first cases since 2016. “All people who have come into contact with a confirmed Ebola patient are given the vaccine, as well as frontline and health workers. The launch started with the vaccination of health workers,” according to a media release from WHO’s Africa region. … … The WHO sent 11 000 doses of the rVSV-ZEBOV Ebola vaccine from its headquarters in Geneva, while a further 8500 doses are being procured from Merck, the vaccine’s producer in the US…”

See also Reuters - Guinea starts Ebola vaccine campaign as cases emerge

And UN News - West Africa steps up efforts to tackle latest Ebola threat

“ As a new Ebola outbreak threatens Guinea, six neighboring countries are urgently scaling up preparation and response efforts to prevent the further spread of the deadly virus, the UN World Health Organization (WHO) said on Thursday….”

PS: “…the UN Central Emergency Response Fund (CERF) has also released $15 million to help Guinea and the Democratic Republic of the Congo (DRC) tackle the resurgence of Ebola, as well as preparedness in countries neighbouring DRC….”

Lancet World Report – Ebola returns to Guinea and DR Congo https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00506-7/fulltext “Experts hope that the capacity and infrastructure put in place for previous epidemics will help to control the new outbreaks. Paul Adepoju reports.”

ODI - New Ebola outbreaks: putting context and community first

K Holloway et al; https://www.odi.org/blogs/17945-new-ebola-outbreaks-putting-context-and- community-first

“The response to recent Ebola outbreaks should be owned by Guinea and the DRC rather than the international community.”

36

Planetary Health

UN News - UN chief lauds ‘day of hope’ as US officially rejoins Paris climate accord https://news.un.org/en/story/2021/02/1085212

This will be a pivotal year for climate crisis (policies), for better (or for worse).

“The conference, known as COP26, will be a “make it or break it occasion” for the common global future, he said.

So far, much work needs to be done still to turn COP 26 into a success…

See Politico - Visionless climate summit hit by ‘lack of political leadership’.

Lancet - The Lancet Pathfinder Commission: pathways to a healthy, zero-carbon future—a call for evidence Andy Haines, Helen Clark et al; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(21)00460-8/fulltext

“…The Lancet Pathfinder Commission aims to synthesise evidence on the development and implementation of multisectoral actions to sustain and improve health, while also accelerating progress towards a net zero-carbon economy. The Commission is comprised of 15 Commissioners who are current or emerging leaders from across multiple disciplines and sectors which encompass the principal domains of planetary health and they are listed in the appendix. The Commission sits within the broader multipartner Pathfinder Initiative, which was established specifically to widen the engagement of stakeholders and dissemination of the Commission's findings. … … We aim for initial findings to be published in The Lancet in advance of COP26 in November, 2021, with a full report to be published ahead of COP27 in 2022….”

Economist – Fossil fuels may be responsible for twice as many deaths as first thought https://www.economist.com/graphic-detail/2021/02/25/fossil-fuels-may-be-responsible-for-twice- as-many-deaths-as-first-thought

“Pollution from burning coal, oil and gas kills millions each year. The toll is heaviest in China and India.” Based on a paper in Environmental research.

B Milanovic - Climate change, covid and global inequality https://glineq.blogspot.com/2021/02/climate-change-covid-and-global.html

37

Usually, we don’t really listen much to Branko Milanovic when he discusses de-growth, but this is a very nice exception. In which he draws some lessons from Covid (for the fight against climate change).

Excerpt: “… Suppose that we draw a list of goods and services such that are (a) carbon intensive and (b) consumed predominantly by the rich. We could then in a concerted international action try to curb consumption of such goods and services while leaving entirely free other decisions: no limits to growth, no degrowth in either poor or rich countries. The entire onus of the adjustment falls on the rich. Who are the rich, viz. the global top decile? About 450 million people from Western countries, or the entire upper half of Western countries’ income distributions; some 30-35 million people from both Eastern Europe and Latin America, that is respectively about 10% and 5% of their total populations; about 160 million people from Asia or 5% of its population; and a very small number of people from Africa. Curbing consumption can be done either through rationing or draconian taxation. Both are feasible technically although their political acceptability may not be the same….”

Decolonize Global Health

Think Global Health - To Decolonize Global Health, We Must Examine the Global Political Economy

P Yerramilli; https://www.thinkglobalhealth.org/article/decolonize-global-health-we-must-examine- global-political-economy

“We cannot talk about decolonizing without discussing colonialism's most fundamental legacy in global health.” Hardhitting piece.

Quote on the Commercial Determinants of Health: “CDOH are defined as "strategies and approaches used by the private sector to promote products and choices that are detrimental to health." While the relationships between specific trade policies and health are complex, CDOH is a useful framework for understanding a global political economy that, on the whole, prioritizes "wealth creation over health creation."

BMJ GH (Editorial) - Closing the diversity and inclusion gaps in francophone public health: a wake-up call V Ridde et al ; https://gh.bmj.com/content/6/2/e005231

« We want to draw attention to the persisting lack of diversity in francophone public health and to stimulate a collective debate to find solutions. … Let us begin by painting a picture of this lack of diversity. We focus on three types of flagship public health institutions: (1) public health authorities and COVID-19 scientific committees (2) public health education and research and (3) public health advocacy groups and societies. To show that our observation persists and transcend beyond borders, we illustrate our point with three French-speaking nations/provinces (France, Quebec and Burkina Faso) from three continents (Europe, North America and Africa) where the three of us have lived and worked. » They also offer some explanations (and some consequences)

38

Excerpt: “The concept of path dependency explains the persistence of epidemiological and biomedical public health in the French-speaking world. It is as if since Pasteur, the world of public health had become frozen and that primary healthcare, the Ottawa Charter or the WHO Commission on Health Determinants never existed. The global definition given by the WHO as early as 1946, highlighting the trilogy of biological, mental and social health, does not seem to have succeeded in influencing this dominant vision of health strongly distorted by a biomedical paradigm, with consequences for the content of interventions, their funding and the nature of academic teaching. The influence of epidemiology in the field of public health persists. But history teaches us that no medicine can fundamentally treat disease without taking into account their sociogenesis. The importance of health seems to be proportional to messages of insecurity and collective fear transmitted by the media and experts. The infantilisation of populations in the fight against the COVID-19 pandemic is a regrettable example of this approach, sad but recurrent. Another explanation is the emergence of bio-power as early as the 19th century, which leaves public health unconstrained by forces that can persuade it to change its paradigm. Despite some progress, francophone public health seems to have missed the opportunity for diversity….

HPW – (Mis)Represented. Our Global Health is UnGlobal.

Fifa A Rahman et al ; https://healthpolicy-watch.news/misrepresented-our-global-health-is- unglobal/

« On 25th February 2021, twenty black and brown leaders in global health, including implementers, academics, civil society, and communities living with the diseases, will convene in a virtual roundtable to discuss how racism and white supremacy affects global health governance, hiring, and programming. This roundtable, convened by Matahari Global Solutions, a global research and policy group, and the AIDS and Rights Alliance of Southern Africa (ARASA), will define the parameters for an in-depth study to take place this year – and advocacy meetings with global health agencies. A meeting report will be published and sent directly to heads of key global health agencies. … … Matahari Global Solutions and AIDS and Rights Alliance for Southern Africa (ARASA) have embarked on an ambitious project to document the various effects of a lack of diversity and white supremacy, on global health programming, hiring, and governance. With a small amount of funding from Open Society Foundations, we’ll start with a roundtable with black and brown leaders in global health, then conduct an in-depth qualitative study to ascertain how whiteness is experienced in global health. Results will be publicised widely – and discussed directly with key global health agencies. We still have to secure funding for a larger quantitative study of over 300 individuals, and advocacy missions by organisations in the Global South on distorted priorities and colonialist global health, to Geneva and New York-based decision-making bodies. But this work is a start. …

R4D – Launch of HSS “Experts database” https://coachingexperts.org/

See New networking platform makes it easier to find health systems strengthening experts, opportunities

“Results for Development and the Strategic Purchasing Africa Resource Center have launched The Experts Database, a publicly accessible, searchable online networking platform for health systems strengthening experts and institutions in Africa and Asia. The platform seeks to elevate the profiles

39

of experts and institutions from the countries and regions that are requesting support for technical assistance, promote The Coaching Approach as a more effective form of support to policymakers and other change agents, while also fostering a more transparent approach to matching country demands with expertise….”

Other news of the week

BBC - Measuring Africa’s Data Gap: The cost of not counting the dead https://www.bbc.com/news/world-africa-55674139

“Only eight African countries out of more than 50 have a compulsory system to register deaths, a BBC investigation has found. … …. All but two countries in Europe - Albania and Monaco - have a universal death registration system, and in Asia, just over half, analysis of UN data shows. But in Africa it is only Egypt, South Africa, Tunisia, Algeria, Cape Verde, São Tomé and Príncipe, Seychelles and Mauritius that have what are called functioning, compulsory and universal civil registration systems - known as CRVS systems - which record deaths….”

Devex - World Bank eyes early IDA replenishment as it boosts spending in COVID- 19 response https://www.devex.com/news/world-bank-eyes-early-ida-replenishment-as-it-boosts-spending-in- covid-19-response-99207

“ The World Bank is allocating funding through the International Development Association faster than expected and has already had discussions with donors to begin the replenishment process ahead of schedule. In response to the COVID-19 crisis, the World Bank has “front-loaded” its spending of IDA funds to support the world’s lowest-income countries, which were intended to last through 2022, World Bank President David Malpass told a small group of journalists Thursday. The World Bank’s commitments were up 65% in 2020 compared with the year before, he said. IDA19, the replenishment that is currently funding operations, was approved in 2019 and meant to last through 2022 when there would be another replenishment. But in response to the pandemic, the World Bank has increased spending and is depleting those resources more rapidly than was planned. Bank donors have met and are considering getting the next replenishment, IDA20, done this year, Malpass said. …. … In October, the bank announced that it would provide $12 billion in financing for COVID-19 vaccines, and last week the board approved three deals related to that effort, with more expected soon. By the end of March, the World Bank expects to have committed $3 billion in grants or loans to help countries purchase vaccines, Malpass said….”

Devex - Q&A: Health hub set to showcase tech-enabled innovations https://www.devex.com/news/sponsored/q-a-health-hub-set-to-showcase-tech-enabled- innovations-99120

“Following the rapid uptake of technology-driven health care solutions amid COVID-19, the Novartis Foundation has launched a learning hub designed to improve population health

40

through health technologies. The HealthTech Dialogue Hub will host events and showcase lessons learned as well as best practices from the roll out of technology-enabled innovations — such as virtual doctors, e-health trackers, and online prescriptions — and facilitate ongoing dialogue between government leaders, health care workers, and innovators…”

Launch of Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) https://www.relabhs.org/about-us/launch/

Took place on 24 Feb. “The Global Launch will highlight the need for integrating rehabilitation within health systems to achieve the Sustainable Development Goals and Universal Health Coverage. … the launch will highlight the consortium’s goals and implementation strategies to address the need for rehabilitation responsive health systems.”

See https://www.relabhs.org/

“Funded by the United States Agency for International Development (USAID), the Learning, Acting and Building for Rehabilitation in Health Systems Consortium (ReLAB-HS) is a global project that will support the development of health systems that are responsive to the growing needs for rehabilitation within populations. It seeks to co-design and implement innovative, comprehensive, cost-effective interventions that strengthen health systems for provision of rehabilitation, including assistive technology. ReLAB-HS will focus on integrating rehabilitation and assistive technology services across all levels of care within health systems. The ReLAB-HS consortium comprises of six international partners with expertise in health systems, implementation science, and delivery innovations.” “…ReLAB-HS will be led by the Johns Hopkins International Injury Research Unit at the Johns Hopkins Bloomberg School of Public Health, USA, and co-led by the Nossal Institute for Global Health, Australia. Other global partners include Humanity & Inclusion, MiracleFeet, Physiopedia, and UCP Wheels for Humanity.”

For a recent blog on the same issue: Disability-inclusive health systems in fragile & shock-prone settings (by Lynda Keeru (ReBuild))

Healthy Developments - Adaptive Social Protection in the Sahel https://health.bmz.de/events/Events_2021/adaptive-social-protection-in-the-sahel/index.html

“A series of workshops to promote effective support for flexible social protection systems.”

“The Sahel countries are struggling with climate change, food insecurity and armed conflict, all posing existential risks to their largely very poor populations. Adaptive Social Protection offers a trajectory for tackling such interrelated challenges and provides a potent framework for policy dialogue and coordinated action with national governments.”

“A three-week marathon of seven intensive workshops, launched in January 2021 by the German Federal Ministry for Economic Cooperation and Development (BMZ), brought together over 90 online participants from the World Bank, UNICEF and the World Food Programme – partners in promoting

41

resilience and addressing needs in the G5 Sahel countries (Burkina Faso, Chad, Mali, Mauritania and Niger). What unites them are their efforts in building systems of Adaptive Social Protection (ASP), an approach that addresses and reduces risks, and fosters prevention by strengthening people’s and societies’ resilience….”

Telegraph - Women have three-quarters of the legal rights of men globally, report finds Telegraph;

“Women around the world have access to just three-quarters of the legal rights of men, and their status is at risk in many countries due to Covid-19, according to a new study from the World Bank. In a major report the organisation found that while there has been slow but steady progress over recent decades, the coronavirus pandemic has put equality in jeopardy across the globe. “In difficult moments, many women start at a disadvantage,” the Women, Business and the Law 2021 report, which assesses the legal framework in which women do business, begins. “The unprecedented challenges of Covid-19 have exposed and deepened global inequality.” …”

Thomson Reuters – Workers' rights under threat as online work surges five-fold - U.N. https://news.trust.org/item/20210223121515-1ph7w/

“Digital platforms have soared five-fold over the past decade, offering opportunities to some but also eroding workers' rights, the International Labour Organization (ILO) said on Tuesday….”

Lancet Anniversary issue on “The Inverse Care Law”

Lancet Editorial – 50 years of the inverse care law https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00505-5/fulltext

“The availability of good medical care tends to vary with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.” These understated opening lines of Julian Tudor Hart's paper, The Inverse Care Law, are as relevant now (50 years to the day since publication) as in 1971. The paper is one of the landmark publications in The Lancet's near 200-year history, and the resonance of Tudor Hart's definition of the inverse care law has global and timeless importance. Simply expressed, Tudor Hart observed that disadvantaged populations need more health care than advantaged populations, but receive less.”

“… Today's anniversary issue of The Lancet explores both the global reach of the inverse care law and primary care initiatives in deprived areas around the UK….”

42

Lancet (Health Policy) – The inverse care law re-examined: a global perspective R Cookson et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00243- 9/fulltext

“An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.”

Via the Lancet Editorial: “… Globally, letting market forces dictate health care is still a major contributor to inequity—private health care can only be accessed by those who can afford to pay. In many countries, social care and long-term care are managed by private providers too. With populations that are living longer and with more chronic conditions, families—rather than the state—bear much of the cost of long-term care. Public funding for long-term care is more means tested (based on both income and wealth) than needs tested. However, that the inverse care law continues to be seen even with integrated universal health-care systems suggests that there are other important causes. As Richard Cookson and colleagues show in a Health Policy paper, the private expenditure share (ie, private spending on health as a fraction of total health spending) in low-income and middle-income countries explains only 11% of the variation in health-care inequality—less than the share explained by poor governance, for example….”

Lancet Comment – The inverse care law in the Anthropocene epoch Andy Haines et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00304- 4/fulltext

“…The insights from the inverse care law and from Tudor Hart's legacy of critical thinking about health care and the political economy of health can guide us today as we navigate the challenges of the Anthropocene epoch. In the Anthropocene, humanity has a dominant role in driving environmental changes as a result of accelerating demands for energy, food, water, infrastructure, and consumer products. … … Tudor Hart's legacy can help to galvanise our efforts to tackle the challenges of the Anthropocene epoch. Strengthening PHC and addressing the environmental and social determinants of ill-health through integrated policies to accelerate climate action are essential to support progress towards health equity in the Anthropocene epoch.”

Some papers and reports of the week

HP&P – Bart Jacobs Tribute Research collection https://blogs.lshtm.ac.uk/hppdebated/2021/02/15/tributes-to-late-doctor-bart-jacobs/

43

“We have collected some tributes from friends and colleagues of Dr Bart Jacobs below and have compiled a Bart Jacobs Tribute Research Collection of his published papers in Health Policy and Planning….”

Issue Paper - Protecting the right to health through inclusive and resilient health care for all R Hammonds; Issue Paper on Protecting the right to health through inclusive and resilient health care for all’

Published by the Office of the Council of Europe Commissioner for Human Rights. The paper was prepared by Dr Rachel Hammonds and forms the basis for 12 recommendations by Commissioner Mijatović to [Council of Europe] member states. Her recommendations set out the various components required to deliver inclusive and resilient health care systems and underline the need for a broader social rights perspective taking into account the social determinants of health. The paper is intended as a tool to help governments address the urgency of protecting the right to health in an environment where health inequalities have been growing and causing significant social, human and economic costs to individuals and societies. The COVID-19 pandemic has compounded this situation, exposing the weaknesses of health care systems strained by years of austerity, economic difficulties and neglect.

Health Security special feature on infodemics https://www.liebertpub.com/toc/hs/19/1

Check it out.

Lancet Review - Improving lung health in low-income and middle-income countries: from challenges to solutions J Meghij et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00458- X/fulltext

“Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.”

44

CGD (Working paper) - The New Era of Unconditional Convergence D Patel, J Sandefur et al ; https://www.cgdev.org/publication/new-era-unconditional-convergence

“The central fact that has motivated the empirics of economic growth—namely unconditional divergence—is no longer true and has not been so for decades. Across a range of data sources, poorer countries have in fact been catching up with richer ones, albeit slowly, since the mid-1990s. This new era of convergence does not stem primarily from growth moderation in the rich world but rather from accelerating growth in the developing world, which has simultaneously become remarkably less volatile and more persistent. Debates about a “middle-income trap” also appear anachronistic: middle-income countries have exhibited higher growth rates than all others since the mid-1980s.”

IDS - Research funders urged to take a collective approach to support impact https://www.ids.ac.uk/news/research-funders-urged-to-take-a-collective-approach-to-support- impact/

“This week research funders will be urged to take a new approach to engaging evidence with policy that values collaborations and learning. As the world continues to be gripped by a pandemic that has prompted renewed political commitment to “following the science” a report from the Impact Initiative for International Development Research finds that it often takes multiple research studies spanning geographies and disciplines to shift understanding and decision making.”

“…This work demonstrated the multiple pathways and contributions of different research projects to social, policy and conceptual change. The report argues that this synthesis work demonstrates the need to look across projects, not just within. The editors make the case for a new collectivised approach to brokering research for development which brings together and profiles multiple types of research and knowledge….”

Some blogs & op-eds of the week

Jason Hickel – Is the world poor or unjust? https://www.jasonhickel.org/blog/2021/2/21/is-the-world-poor-or-unjust

Starting from a recent debate on Twitter: “…A couple of economists on Twitter have claimed that the world average income is $16 per day (PPP). This, they say, is proof that the world is poor in a much more general sense: there is not enough for everyone to live well, and the only way to solve this problem is to press on the accelerator of aggregate economic growth. …”

Hickel, however, comes to the following conclusion, after listing three arguments (The world is richer than you think; 2. GDP accounting does not reflect economic value; 3. What matters is resources and provisioning) : : “…There is no scarcity. Rather, the world’s resources and energy are appropriated (disproportionately from the global South) in order to service the interests of capital and affluent consumers (disproportionately in the global North). We can state it more clearly: our economic system is not designed to meet human needs; it is designed to facilitate capital

45

accumulation. And in order to do so, it imposes brutal scarcity on the majority of people, and cheapens human and nonhuman life. It is irrational to believe that simply “growing” such an economy, in aggregate, will somehow magically achieve the social outcomes we want.”…”

Guardian - Covid and the climate crisis show why we need a new social contract between old and young M Shafik; https://www.theguardian.com/commentisfree/2021/feb/25/covid-climate-crisis-new- social-contract-old-young

“The burden to pay for people in retirement is too great on those facing debt, job insecurity and an uncertain future.”

Some tweets of the week

Jason Hickel “Those who defend capitalism by saying it "allocates resources efficiently" need to explain why billionaires proliferate while 60% of the global population is unable to meet basic human needs.”

Balasubramaniam (@ThiruGeneva ) “The 55 member states of the African Union endorse the TRIPS waiver proposal - "DECIDES to support the proposed WTO Waiver from certain provisions of the TRIPS Agreement for the Prevention, Containment and Treatment of COVID-19 as contained in WTO Document IP/C/W/669". “

“KEI Europe comments on the European Health Emergency Preparedness and Response Authority (HERA) roadmap https://keieurope.org/2021/02/24/kei-europe-comments-on-the-european- health-emergency-preparedness-and-response-authority-hera-road-map/ "Whilst calls for better coordination in the EU pandemic response are welcome, HERA must put the global right to health, rather than regional biosecurity concerns, at its heart." … "The lack of global solidarity, particularly as developing countries, appears to be a common thread throughout this proposal, which is regrettable."… … "The new voluntary licensing mechanism should not have a geographic limit."…”

Geneva Health Files “How @adarpoonawalla became a poster boy for countries opposing the #TRIPSwaiver proposal @wto Some countries opposing the proposal reportedly cited a statement by A Poonawalla, @SerumInstIndia where he told The Guardian that there is sufficient vaccine manufacture capacity.”

Mogha Kamal-Yanni “The Holy Sea: , a large number of manufacturing facilities, with proven capacity to produce safe and effective vaccines, are unable to utilize those capacities, due, inter alia, to IP barriers.”

46

Global health events

Coming up – 31 March: Final stage (2020) HSR symposium https://healthsystemsglobal.org/news/join-us-for-the-culmination-of-hsr2020/

Join Health Systems Global and partners on 31 March for the third and final phase of the virtual Sixth Global Symposium on Health Systems Research (HSR2020). “… Phase 3 of HSR2020 will be an opportunity to reflect on the valuable evidence and learnings exchanged during the first two symposium phases and consider how these might help us reimagine health systems for better health and social justice from and beyond the global impact of COVID-19. The culmination of HSR2020 will also mark the first steps towards the Seventh Global Symposium in Bogota in 2022….”

HPW - Global Health Diplomacy In The COVID-19 Era – Can Failure Usher In A New Era of Success? https://healthpolicy-watch.news/global-health-diplomacy-in-the-covid-19-era-can-failure-usher-in- a-new-era-of-success/

Coverage of the launch of the Global Health Diplomacy handbook last week (in Geneva).

PMAC 2021 sessions – all recordings are available now

On the conference website www.pmac2021.com.

Global governance of health

Devex - Exclusive: Audit finds nepotism, corruption, and worse at the African Union Commission https://www.devex.com/news/exclusive-audit-finds-nepotism-corruption-and-worse-at-the-african- union-commission-99181

“An independent forensic audit report has confirmed the extensive allegations of nepotism, corruption, financial mismanagement, power abuse, and sexual harassment that have constantly plagued AUC.”

Devex - First African IFC head pledges to focus on world's poorest countries https://www.devex.com/news/first-african-ifc-head-pledges-to-focus-on-world-s-poorest-countries- 99204

“Makhtar Diop, who was named the head of the International Finance Corporation on Thursday, said he is joining the institution at a “critical juncture in the global recovery” and will push it to do

47

more work in the world’s poorest and most fragile states, especially in Africa. IFC’s mission is “more important than ever,” and the institution is “well-suited” to respond to the challenge of COVID-19, Diop said on a call with a small group of journalists Thursday. Diop, a Senegalese former finance minister, is IFC’s first African leader and comes to the institution after a long career at the World Bank, where he is currently serving as vice president for infrastructure. Diop was brought on to strengthen the implementation of IFC’s mission and its IFC 3.0 strategy, which aims to refocus the institution on delivering greater development impact in the world’s poorest countries, World Bank President David Malpass said on the same call….”

Devex - UK government rejects aid cut information request 'for commercial reasons' https://www.devex.com/news/uk-government-rejects-aid-cut-information-request-for-commercial- reasons-99228

“The British government has denied a freedom of information request about cuts to the aid budget, fuelling further complaints about the transparency of its development policy. The government said it could not provide information about the £2.9 billion ( $3.7 billion) reduction made in July 2020 to Bond, the U.K. network for NGOS, because of “commercial interest” and because the information would be provided in the future….”

CGD - How an Allocation of IMF SDRs To Africa Could Be Supported by A Multilateral Reallocation Initiative D Sembene; https://www.cgdev.org/blog/how-allocation-imf-sdrs-africa-could-be-supported- multilateral-reallocation-initiative#.YDT5LY4xER0.twitter

“To support pandemic response in low-income countries (LICs), the case for a new allocation of IMF special drawing right (SDRs)s has been pervasively made in recent months. Building on a forthcoming CGD publication, this piece documents how such a move would specifically support Africa and how its lowest income countries could benefit from SDR reallocation by IMF largest shareholders….”

Chapter - Preparing for the Next Pandemic: the International Health Regulations and World Health Organization during COVID-19 G L Burci et al ; https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3719102

“In this chapter we will focus on how the current IHR have limited utility during a pandemic, most notably in respect of a coordinated approach among states and international institutions and across international legal regimes to deliver the assets that are most important to sustain a global response, reduce the economic and social suffering, and allow the international community to “build back better”. We argue that the Regulations themselves are inadequately balanced at present, with insufficient attention given to the third and fourth aims of the Regulations: to “control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks.” In this chapter, we firstly outline some of the key strengths and distinguishing features of the IHR as an international legal instrument, which we caution against diluting or removing in the event of the IHR being revised post-COVID. From this we also identify one major area for future reform of the IHR, highlighting how the world and WHO can be better prepared to sustainably respond to the next pandemic.”

48

UHC

HP&P - Does community-based health insurance improve access to care in sub- Saharan Africa? A rapid review J Artignan et al ; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czaa174/6148921?searchresult=1

“In sub-Saharan African countries, out-of-pocket payments can be a major barrier to accessing appropriate healthcare services. Community-based health insurance (CBHI) has emerged as a context-appropriate risk-pooling mechanism to provide some financial protection to populations without access to formal health insurance. The aim of this rapid review was to examine the peer- reviewed literature on the impact of CBHI on the use of healthcare services as well as its capacity to improve equity in the use of healthcare between different socio-economic groups….”

“…They provide strong evidence that community-based health insurance can contribute to improving access to outpatient care and weak evidence that they improve access to inpatient care. There was low evidence on their capacity to improve equity in access to healthcare among insured members. In the absence of sufficient public spending for healthcare, such schemes may be able to provide some valuable benefits for communities with limited access to primary-level care in sub-Saharan Africa. The overall high risk of bias of the studies and the wide existing variety of insurance arrangements suggest caution in generalizing these results.”

BMJ GH - Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda Joël A Kiendrébéogo et al ; https://gh.bmj.com/content/6/2/e004273

“Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project….”

Planetary health

Devex - Least developed countries urge climate finance help at UN Security Council https://www.devex.com/news/least-developed-countries-urge-climate-finance-help-at-un-security- council-99236

“Dozens of least developed countries have called for the United Nations Security Council to encourage governments to make climate finance targets a reality at the 2021 U.N. Climate Change Conference, or COP26….”

49

Guardian - Global freshwater fish populations at risk of extinction, study finds https://www.theguardian.com/environment/2021/feb/23/global-freshwater-fish-populations-at- risk-of-extinction-study-finds

“World’s Forgotten Fishes report lists pollution, overfishing and climate change as dangers.”

Devex - Climate migration keeps growing — but doesn't look as you might expect https://www.devex.com/news/climate-migration-keeps-growing-but-doesn-t-look-as-you-might- expect-99214

“People forced to migrate because of climate change tend to stay as close as possible to their homes. But public recognition — and development funding trends — have largely yet to mirror this reality, migration experts say.”

HPW - Over 160,000 Deaths in Five Biggest Cities Linked to Air Pollution in 2020 https://healthpolicy-watch.news/82703-2/

“Air pollution has been linked to the deaths of 160,000 people in the world’s five biggest cities in 2020, according a global report by Greenpeace Southeast Asia and IQAir, the world’s largest free air quality information platform. Of the five biggest cities, Delhi had the most deaths (54,000) due to PM2.5 air pollution in 2020 – one death per 500 people. It was followed by Tokyo (40,000) and Shanghai (39,000). Sao Paulo and Mexico City had an estimated 15,000 each. Greenpeace and IQAir collaborated on the ‘cost of air pollution estimator’ for 26 cities, drawing on data from over 80,000 air sensors in IQAir’s air quality database. …”

FT - The new politics of climate change https://www.ft.com/content/b6bdc4b1-d41f-49f0-a3df-61614cc1a2b7

“Global warming has made environmentalists of us all. Yet debate still rages over what is the best solution.”

“A billionaire, a novelist and a professor all write a book about climate change. That may sound like the start of a joke but it is not, especially for philanthropist Bill Gates and author Jonathan Franzen. Their books have come out just as Michael E Mann, one of the world’s best known climate scientists, has published a book accusing each of abetting new forces of inactivism slowing efforts to tackle climate change….”

Excerpts: “…. Mann argues that it is still possible to avert 2C of warming and that every bit of carbon that is not burnt prevents additional damage. “There is both urgency and agency,” he says. Social and political changes also give him cause for cautious optimism. Apart from the fact that outright denialism is fading and that climate action advocates such as Joe Biden are being elected, he is buoyed by the youth climate movement and the rise of investors rethinking the risks of fossil fuel investments. In addition, he thinks the Covid crisis has reawakened appreciation of science, while

50

pandemic recovery plans have opened opportunities for green investments. “We appear to be nearing the much-anticipated tipping point on climate action,” he writes. Yet the urgency of the problem remains, which is what leads Mann to cite Bill Gates on several charges of climate inactivism….”

“… For Mann, these [geo-engineering ] schemes come under the heading of “dangerous techno- fixes” that appeal to free-market conservatives — by suggesting government regulation is unnecessary — but entail hugely risky “tinkering” with complex Earth systems we do not fully understand. Gates acknowledges such concerns, admitting that unproven geoengineering concepts raise “thorny ethical issues”. He adds that his funding for such efforts is “tiny” compared to his other climate financing. But he still thinks the approach is worth investigating “while we still have the luxury of study and debate”. The idea that there is time to develop meaningful climate solutions underpins a central theme of the book, namely that existing green technologies are not enough and must be augmented by big innovation breakthroughs. “We have some of what we need, but far from all of it,” he says. …. … This puts Gates on one side of a debate between those who think the climate problem will be solved by technology, versus those who believe the technology needed is here and what is required is more political will and policies to deploy it. Mann belongs to the latter camp. “Sorry Bill Gates, but we don’t need a miracle,” he writes, pointing to academics who showed years ago that existing renewable energy and storage technologies could meet up to 80 per cent of global energy demand by 2030, and 100 per cent by 2050….”

Infectious diseases & NTDs

Reuters - Russia reports world's first case of human infection with H5N8 bird flu

Reuters

« Russia has registered the first case of a strain of bird flu virus named A(H5N8) being passed to humans from birds and has reported the matter to the World Health Organization (WHO), Anna Popova, head of consumer health watchdog Rospotrebnadzor, said on Saturday….”

Tweet Alexandra Phelan:

« The most concerning aspect of this morning's H5N8 news is not necessarily that we now have evidence of human infection from H5N8 influenza, but that it took ~two months to report it to WHO. This is what noncompliance with international law or weakened legal norms look like. »

Lancet Global Health (Comment) - Decentralisation, integration, and task-shifting: tools to accelerate the elimination of hepatitis C https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00055-3/fulltext

“…. Scaling up, decentralising, and integrating HCV services will need champions in all parts of the health system. “

Linked to a new review in the Lancet Global Health: Decentralisation, integration, and task-shifting in hepatitis C virus infection testing and treatment: a global systematic review and meta-analysis

51

Conclusion: “Decentralisation and integration of HCV care to harm-reduction sites or primary care showed some evidence of improved access to testing, linkage to care, and treatment, and task- shifting of care and treatment to non-specialists was associated with similarly high cure rates to care delivered by specialists, across a range of populations and settings. These findings provide support for the adoption of decentralisation and task-shifting to non-specialists in national HCV programmes.”

Scidev.net - Africa ‘not on track to reach 2030 HIV/AIDS targets’ https://www.scidev.net/global/news/africa-not-on-track-to-reach-2030-hiv-aids-targets/

“Researchers estimated the likelihood of 38 African countries reaching 2030 HIV/AIDS targets; The chances of reaching HIV testing or condom use targets are less than 30 per cent…”

For the related study, see Progress toward HIV elimination goals: trends in and projections of treatment as prevention strategy in 38 African countries.

Devex - Q&A: Tackling two deadly diseases one health system at a time https://www.devex.com/news/sponsored/q-a-tackling-two-deadly-diseases-one-health-system-at-a- time-99142

“Pharmaceutical giant GSK has teamed up with Amref Health Africa to reduce malaria and tuberculosis deaths in Ethiopia and Kenya by 80% over the next two years, while simultaneously strengthening the countries’ health systems. … … The new tackling malaria and TB in Kenya and Ethiopia program, three-fold in its purpose, plans to reduce the burden of these diseases, reverse any setbacks caused by COVID-19, and then accelerate the gains in tackling the two. It will do so by leveraging Amref’s expertise in community engagement and GSK’s research and development strengths, Gitahi said….”

Plos Med - Assessing the impact of preventive mass vaccination campaigns on yellow fever outbreaks in Africa: A population-level self-controlled case series study https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003523

New research provides empirical evidence of the high preventive impact of preventive mass #vaccination campaigns on #yellowfever outbreaks.

And a link:

Lancet Comment - Mini-outbreak response for malaria using indoor residual spraying.

52

AMR

Final report of the inaugural online meeting of the Global Leaders Group on Antimicrobial Resistance. January 26-27, 2021. https://cdn.who.int/media/docs/default-source/antimicrobial-resistance/amr-gcp-tjs/glg-inaugural- meeting-report.pdf?sfvrsn=1c171c9_12

4 p. “The inaugural online meeting of the One Health Global Leaders Group (GLG) on Antimicrobial Resistance (AMR) was held on January 26 and 27, 2021 (14:00-16:00 Central European Time) with the objectives of introducing the GLG members; sharing ideas, perspectives and vision for its work; and discussing indicative, prioritized actions proposed by the GLG members….”

NCDs

WHO – WHO NCD Lab - First Call for Innovative Cross Cutting Initiatives https://www.who.int/news-room/articles-detail/ncd-lab-first-call

“The WHO Global Coordination Mechanism on NCDs (GCM/NCD) is launching the first cycle of the Noncommunicable Disease Lab (NCD Lab), a new virtual platform that supports submissions that harness innovative solutions to accelerate progress towards achieving the NCD and NCD-related SDGs….”

Link:

Movendi - African, European Communities Denounce European Union External Action Collusion with Big Alcohol, Make 3 Requests for Change

Sexual & Reproductive / maternal, neonatal & child health

Lancet Global Health (Comment) – The conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1 https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00030-9/fulltext

“The UN's Sustainable Development Goals (SDGs) agenda, by contrast to the Millennium Development Goals, provides a global policy framework to address the quality of life of beneficiaries of the remarkable reduction in mortality in those younger than 5 years since the child survival revolution began in 1982. The SDGs explicitly commit all governments and the global health community to actions that will “ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”. To monitor progress towards achieving this target, “the proportion of children under 5 years of age

53

who are developmentally on track in health, learning and psychosocial well-being, by sex” was chosen as the sole indicator (SDG 4.2.1). … … However, the Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs), which was established in 2015 by the UN to facilitate the implementation of all indicators, has proposed the exclusion of all children younger than 24 months from SDG 4.2.1, subject to final approval by the UN Statistical Commission in March, 2021 (panel). This proposal is attributable to the inability of UNICEF, as the custodian agency, to provide a suitable population-level measure of functioning and development in children younger than 24 months. … … The proposed exclusion of all children younger than 24 months from the sole global indicator for early childhood development is of great concern for several reasons….”

BMJ GH - A double-edged sword—telemedicine for maternal care during COVID- 19: findings from a global mixed-methods study of healthcare providers

A Galle, L Benova et al ; https://gh.bmj.com/content/6/2/e004575

“The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally….”

Lancet Global Health (Health Policy) - A public health approach for deciding policy on infant feeding and mother–infant contact in the context of COVID-19 N Rollins et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30538- 6/fulltext

“The COVID-19 pandemic has raised concern about the possibility and effects of mother–infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother–infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches might affect infant mortality. Based on existing evidence, including population and survival estimates, the number of infant deaths in low-income and middle- income countries due to COVID-19 (2020–21) might range between 1800 and 2800. By contrast, if mothers with confirmed SARS-CoV-2 infection are recommended to separate from their newborn babies and avoid or stop breastfeeding, additional deaths among infants would range between 188 000 and 273 000.”

SRHM - Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights Lucy Wilson et al ; https://www.tandfonline.com/doi/full/10.1080/26410397.2021.1882791

“Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and

54

missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields.”

Access to medicines

Global Health Action - Making a COVID-19 vaccine that works for everyone: ensuring equity and inclusivity in clinical trials T Pepperell et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1892309

“Coronavirus disease 2019 (COVID-19) mortality and morbidity have been shown to increase with deprivation and impact non-White ethnicities more severely. Despite the extra risk Black, Asian and Minority Ethnicity (BAME) groups face in the pandemic, our current medical research system seems to prioritise innovation aimed at people of European descent. We found significant difficulties in assessing baseline demographics in clinical trials for COVID-19 vaccines, displaying a lack of transparency in reporting. Further, we found that most of these trials take place in high-income countries, with only 25 of 219 trials (11.4%) taking place in lower middle- or low-income countries. Trials for the current best vaccine candidates (BNT162b2, ChadOx1, mRNA-173) recruited 80.0% White participants. Underrepresentation of BAME groups in medical research will perpetuate historical distrust in healthcare processes, and poses a risk of unknown differences in efficacy and safety of these vaccines by phenotype. Limiting trial demographics and settings will mean a lack of global applicability of the results of COVID-19 vaccine trials, which will slow progress towards ending the pandemic.”

BMJ GH - Can we do for other essential medicines what we are doing for the COVID-19 vaccine? A Murphy, E Torreele et al ; https://gh.bmj.com/content/6/2/e005158

“The resources that have been mobilised to accelerate the development and distribution of the COVID-19 vaccine are unprecedented. We ask what could be achieved if similar resources were dedicated to improving access to medicines and other health technologies for conditions that affect many more people. In 2017, an estimated two billion people did not have access to essential medicines, including for diseases with well-established treatment options like cardiovascular disease and diabetes. The COVID-19 vaccine experience has shown us the scale and pace of resource mobilisation and innovation that we are capable of – this must now be applied to ensuring equitable access not only to the COVID-19 vaccine but to all essential medicines and health technologies.”

Link:

Stat - Access to heart drugs improves in middle-income countries, but still lags compared to wealthy nations

55

Social determinants of health

WHO ( EB resolution) - Social determinants of health https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_R2-en.pdf

Recent @WHO EB resolution (22 Jan) text on #SDoH calls for a new global report, operational framework and stronger monitoring guidance.

SS&M - How are social determinants of health integrated into epigenetic research? A systematic review https://www.sciencedirect.com/science/article/abs/pii/S0277953621000708

The authors systematically review the literature on social epigenetics, examining how empirical research to date has conceptualized and operationalized social determinants of health (SDOH).

Extra Covid section

CGD (blog) - Creating Effective Research-Policy Partnerships for COVID Response and Beyond

S Rose et al; https://www.cgdev.org/blog/creating-effective-research-policy-parterships-covid- response-and-beyond

“… Last month, CGD and Innovations for Poverty Action (IPA) hosted a conversation with policymakers (Daniel Gomez Gaviria from Colombia’s National Planning Department), researchers (Radha Rajkotia from IPA and Maryam Akmal, then at CGD), and donors (USAID’s Josh Kaufman and Eunice Yaa Brimfah Ackwerh from the World Bank’s Ghana office) to explore how the pandemic has impacted the engagement between policymakers and researchers. The discussion highlighted several key lessons to inform partnership approaches for evidence-based policymaking throughout the COVID response and beyond. With an eye toward being better prepared to meet the evidence needs that may arise in future crises, we point to five key themes below….”

Reuters - World Bank threatens to stop funding Lebanon's COVID-19 vaccines after reported violations Reuters;

“The World Bank threatened to suspend financing for Lebanon’s COVID-19 vaccination drive in its second week after it emerged that some lawmakers would get their shots in parliament on Tuesday….”

56

Project Syndicate - Three Vaccine Assumptions for 2021 S K Khor; https://www.project-syndicate.org/commentary/three-covid19-vaccine-predictions-for- 2021-by-swee-kheng-khor-1-2021-01

“As COVID-19 vaccination programs scale up globally, they must be able to withstand reality. Policymakers need to incorporate three realistic assumptions into their immunization plans: delays are inevitable, inequality will increase, and vaccine procurement could be a proxy for geopolitics.”

BMJ Open - The pandemic of online research in times of COVID-19 Jeroen de Man et al; https://bmjopen.bmj.com/content/11/2/e043866.full

“The COVID-19 pandemic has led to an explosion of online research using rating scales. While this approach can be useful, two of the major challenges affecting the quality of this type of research include selection bias and the use of non-validated scales. Online research is prone to various forms of selection bias, including self-selection bias, non-response bias or only reaching specific subgroups. The use of rating scales requires contextually validated scales that meet psychometrical properties such as validity, reliability and—for cross-country comparisons—invariance across settings. We discuss options to prevent or tackle these challenges. Researchers, readers, editors and reviewers need to take a critical stance towards research using this type of methodology.”

WEF - COVID-19: The $4 trillion cost of not vaccinating everyone https://www.weforum.org/agenda/2021/02/the-4-trillion-economic-cost-of-not-vaccinating-the- entire-world/

“… Our results showed that if wealthier nations are fully vaccinated by the middle of this year – a goal that many countries are striving for – yet developing countries manage to vaccinate only half of their populations, the global economic loss would amount to around US$4 trillion. We estimated the global economic cost of developing countries not vaccinating any of their citizens to be around $9 trillion…”

57